Provider Demographics
NPI:1457369183
Name:REDDY, SREEJAYA (MD)
Entity Type:Individual
Prefix:MRS
First Name:SREEJAYA
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 1:101 STATE AVENUE
Mailing Address - Street 2:STE B
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141
Mailing Address - Country:US
Mailing Address - Phone:270-651-1437
Mailing Address - Fax:280-651-2617
Practice Address - Street 1:101 STATE AVENUE
Practice Address - Street 2:STE B
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141
Practice Address - Country:US
Practice Address - Phone:270-651-1437
Practice Address - Fax:280-651-2617
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21028207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64210289Medicaid
C74900Medicare UPIN
KY64210289Medicaid