Provider Demographics
NPI:1265719355
Name:REDDY, ANANTHA R (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:ANANTHA
Middle Name:R
Last Name:REDDY
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:360 EAST 194 STREET
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-4525
Mailing Address - Country:US
Mailing Address - Phone:718-365-2603
Mailing Address - Fax:
Practice Address - Street 1:2527 VALENTINE AVE
Practice Address - Street 2:3WA
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458
Practice Address - Country:US
Practice Address - Phone:718-365-2603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF341186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily