Provider Demographics
NPI:1770259954
Name:KOMMMAREDDY, SRIKAR
Entity Type:Individual
Prefix:
First Name:SRIKAR
Middle Name:
Last Name:KOMMMAREDDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17676 WESTHAMPTON WOODS DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-6332
Mailing Address - Country:US
Mailing Address - Phone:314-856-8041
Mailing Address - Fax:
Practice Address - Street 1:17676 WESTHAMPTON WOODS DR
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63005-6332
Practice Address - Country:US
Practice Address - Phone:314-856-8041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program