Provider Demographics
NPI:1003552795
Name:KANDALA, VINEETH REDDY (MD)
Entity type:Individual
Prefix:
First Name:VINEETH REDDY
Middle Name:
Last Name:KANDALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VINEETH
Other - Middle Name:REDDY
Other - Last Name:KANDALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7373 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4373
Mailing Address - Country:US
Mailing Address - Phone:225-246-9790
Mailing Address - Fax:225-246-9160
Practice Address - Street 1:2315 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4031
Practice Address - Country:US
Practice Address - Phone:225-763-4764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2025-07-16
Deactivation Date:2022-12-13
Deactivation Code:
Reactivation Date:2023-07-20
Provider Licenses
StateLicense IDTaxonomies
LA346750207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine