Provider Demographics
NPI:1336257237
Name:REDDY, VEERA N (MD)
Entity Type:Individual
Prefix:DR
First Name:VEERA
Middle Name:N
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1955
Mailing Address - Country:US
Mailing Address - Phone:573-756-5353
Mailing Address - Fax:573-756-4557
Practice Address - Street 1:1010 W COLUMBIA ST
Practice Address - Street 2:SOUTHEAST MISSOURI MENTAL HEALTH CENTER
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-2902
Practice Address - Country:US
Practice Address - Phone:573-218-6792
Practice Address - Fax:573-218-6703
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1054982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO105498OtherMO PROFESSIONAL LICENSE
MO206977142Medicaid