Provider Demographics
NPI:1316098163
Name:REDDY, SANTHI SANAGALA
Entity type:Individual
Prefix:DR
First Name:SANTHI
Middle Name:SANAGALA
Last Name:REDDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S AUSTRALIAN AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401
Mailing Address - Country:US
Mailing Address - Phone:561-805-8500
Mailing Address - Fax:561-805-8501
Practice Address - Street 1:1200 WEST GRANADA BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-615-8122
Practice Address - Fax:386-615-8137
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96284207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION63430Medicare ID - Type Unspecified
H09091Medicare UPIN