Provider Demographics
NPI:1831539964
Name:REDDY, PRAVEEN A (PA)
Entity type:Individual
Prefix:
First Name:PRAVEEN
Middle Name:A
Last Name:REDDY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 WOLF DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-1306
Mailing Address - Country:US
Mailing Address - Phone:203-952-3230
Mailing Address - Fax:
Practice Address - Street 1:801 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-2276
Practice Address - Country:US
Practice Address - Phone:203-952-3230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant