Provider Demographics
NPI:1295774305
Name:REDDY, SHYLA (MD)
Entity type:Individual
Prefix:
First Name:SHYLA
Middle Name:
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:PO BOX 1385
Mailing Address - Street 2:P O BOX 1385
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1385
Mailing Address - Country:US
Mailing Address - Phone:678-619-1974
Mailing Address - Fax:678-619-1975
Practice Address - Street 1:480 N MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-8386
Practice Address - Country:US
Practice Address - Phone:678-619-1974
Practice Address - Fax:678-619-1975
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25425207QG0300X
GA71622207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009932265Medicaid
LA1167568Medicaid
AL01-12861OtherUNITED HEALTH CARE
GA202I085489OtherMEDICARE PTAN
FL268099800Medicaid
AL51538045OtherBLUE CROSS
MS01778200Medicaid
AL51518001OtherBLUE CROSS
GA003148835AMedicaid
AL051518001Medicare ID - Type Unspecified
GA003148835AMedicaid
AL01-12861OtherUNITED HEALTH CARE