Provider Demographics
NPI:1184245680
Name:NANJA REDDY, SUSHMITHA
Entity type:Individual
Prefix:
First Name:SUSHMITHA
Middle Name:
Last Name:NANJA REDDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DETROIT MEDICAL CENTER GME OFFICE 4201 ST ANTOINE
Mailing Address - Street 2:UHC-9C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-745-5146
Mailing Address - Fax:313-966-0880
Practice Address - Street 1:DETROIT MEDCEN SINAI GRACE HOSPITAL DPT OF INTERNAL MED
Practice Address - Street 2:6071 W OUTER DRIVE
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:313-966-7434
Practice Address - Fax:313-966-1738
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program