Provider Demographics
NPI:1316900012
Name:REDDY, SRAVANTHI R (M D)
Entity type:Individual
Prefix:DR
First Name:SRAVANTHI
Middle Name:R
Last Name:REDDY
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7229
Mailing Address - Country:US
Mailing Address - Phone:575-534-1919
Mailing Address - Fax:575-534-0135
Practice Address - Street 1:1268 E 32ND ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7229
Practice Address - Country:US
Practice Address - Phone:575-534-1919
Practice Address - Fax:575-534-0135
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM2001-286208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM72330562Medicaid
NMBR6341921OtherDEA
NM348535102Medicare PIN
NMBR6341921OtherDEA
NM72330562Medicaid