Provider Demographics
NPI:1013973882
Name:SINGIREDDY, SUKHENDER R (MD)
Entity Type:Individual
Prefix:DR
First Name:SUKHENDER
Middle Name:R
Last Name:SINGIREDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:880 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-7851
Mailing Address - Country:US
Mailing Address - Phone:386-677-6928
Mailing Address - Fax:386-304-3135
Practice Address - Street 1:1728 DUNLAWTON AVE
Practice Address - Street 2:STE 5
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-2922
Practice Address - Country:US
Practice Address - Phone:386-304-3404
Practice Address - Fax:386-304-3135
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00813952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00387686OtherRR MEDICARE
FL260108700Medicaid
P00387686OtherRR MEDICARE
FLG95102Medicare UPIN
FLE4902SMedicare PIN