Provider Demographics
NPI:1306580089
Name:DEPA, NISHITHA REDDY (MD)
Entity type:Individual
Prefix:MS
First Name:NISHITHA
Middle Name:REDDY
Last Name:DEPA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MOUNIKA
Other - Middle Name:REDDY
Other - Last Name:DEPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 DAME GRUEV DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARKHAM
Mailing Address - State:ON
Mailing Address - Zip Code:LGE OM4
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:183 S ORANGE AVE
Practice Address - Street 2:BEHAVIORAL SCIENCE BUILDING E1452
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:973-972-4670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2023-03-08
Deactivation Date:2023-01-30
Deactivation Code:
Reactivation Date:2023-03-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program