Provider Demographics
NPI:1184904583
Name:REDDI, SUDAMA (MD)
Entity type:Individual
Prefix:
First Name:SUDAMA
Middle Name:
Last Name:REDDI
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 1:6124 W PARKER RD
Mailing Address - Street 2:SUITE 432
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8122
Mailing Address - Country:US
Mailing Address - Phone:972-403-3100
Mailing Address - Fax:972-403-3105
Practice Address - Street 1:6124 W PARKER RD
Practice Address - Street 2:SUITE 432
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8122
Practice Address - Country:US
Practice Address - Phone:972-403-3100
Practice Address - Fax:972-403-3105
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ08152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology