Provider Demographics
NPI:1790987964
Name:REDDY, KONDA MOHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KONDA
Middle Name:MOHAN
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 LEE RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2167
Mailing Address - Country:US
Mailing Address - Phone:407-896-2901
Mailing Address - Fax:407-896-2902
Practice Address - Street 1:1801 LEE RD STE 170
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789
Practice Address - Country:US
Practice Address - Phone:407-896-2901
Practice Address - Fax:407-896-2902
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1038302080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology