Provider Demographics
NPI:1962667535
Name:MALLIPEDDI, SAHITYA (MD)
Entity Type:Individual
Prefix:
First Name:SAHITYA
Middle Name:
Last Name:MALLIPEDDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SOUTHFIELD DR STE 1330
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4499
Mailing Address - Country:US
Mailing Address - Phone:317-837-5510
Mailing Address - Fax:317-837-5520
Practice Address - Street 1:1100 SOUTHFIELD DR STE 1330
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168
Practice Address - Country:US
Practice Address - Phone:317-837-5510
Practice Address - Fax:317-837-5520
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268918207R00000X
IN01079074A207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300006327Medicaid