Provider Demographics
NPI:1245292234
Name:REDDY, SARALA K (MD)
Entity type:Individual
Prefix:
First Name:SARALA
Middle Name:K
Last Name:REDDY
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 1:755 PARK AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-784-7803
Mailing Address - Fax:631-784-7814
Practice Address - Street 1:755 PARK AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-784-7803
Practice Address - Fax:631-784-7814
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1681362084P0800X
NY001681362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA48438OtherMDNY
NY01041249Medicaid
NY04101900001OtherFIDELIS
NY04101900001OtherFIDELIS
NY08E691Medicare PIN