Provider Demographics
NPI:1104917913
Name:REDDY, SUREKHA N (MD)
Entity type:Individual
Prefix:DR
First Name:SUREKHA
Middle Name:N
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 1:777 12TH ST STE 250
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-1929
Mailing Address - Country:US
Mailing Address - Phone:916-550-5487
Mailing Address - Fax:
Practice Address - Street 1:5959 GREENBACK LN STE 500
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-4700
Practice Address - Country:US
Practice Address - Phone:916-725-1177
Practice Address - Fax:916-877-8225
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81664208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A816640Medicaid
CA00A816640Medicaid
00A816640Medicare ID - Type Unspecified
CA00A816641Medicare PIN