Provider Demographics
NPI:1275535536
Name:REDDY, VINAY KUMAR PUCHALAPALLI (MD)
Entity type:Individual
Prefix:DR
First Name:VINAY
Middle Name:KUMAR PUCHALAPALLI
Last Name:REDDY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:938 CYPRESS VILLAGE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6835
Mailing Address - Country:US
Mailing Address - Phone:813-333-5080
Mailing Address - Fax:813-773-7717
Practice Address - Street 1:938 CYPRESS VILLAGE BLVD STE A
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6835
Practice Address - Country:US
Practice Address - Phone:813-333-5080
Practice Address - Fax:813-773-7717
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL172397207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000322080OtherANTHEM PROVIDER NUMBER
IN000000322080OtherANTHEM PROVIDER NUMBER
ING12919Medicare UPIN
IN216920AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER