Provider Demographics
NPI:1295114932
Name:REDDY, AMULYA (DO)
Entity type:Individual
Prefix:DR
First Name:AMULYA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 S CRISMON RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3767
Mailing Address - Country:US
Mailing Address - Phone:480-358-6450
Mailing Address - Fax:
Practice Address - Street 1:1830 MEDITERRANEAN DR
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3144
Practice Address - Country:US
Practice Address - Phone:815-766-3873
Practice Address - Fax:815-766-7713
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60851254207RG0100X
390200000X
IL036171421207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program