Provider Demographics
NPI:1356190631
Name:MARAMREDDY, SUPRIYA
Entity type:Individual
Prefix:
First Name:SUPRIYA
Middle Name:
Last Name:MARAMREDDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 KISSEL AVE
Mailing Address - Street 2:APT 2E
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310
Mailing Address - Country:US
Mailing Address - Phone:919-293-2137
Mailing Address - Fax:
Practice Address - Street 1:355 BARD AVENUE
Practice Address - Street 2:DEPARTMENT OF MEDICINE, VILLA BUILDING, 1ST FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310
Practice Address - Country:US
Practice Address - Phone:718-818-1645
Practice Address - Fax:718-818-3225
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2025-02-10
Deactivation Date:2025-01-13
Deactivation Code:
Reactivation Date:2025-02-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program