Provider Demographics
NPI:1316956741
Name:REDDY, SHRIMANI (MD)
Entity type:Individual
Prefix:DR
First Name:SHRIMANI
Middle Name:
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 1:216 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:PIERSON
Mailing Address - State:FL
Mailing Address - Zip Code:32180-3024
Mailing Address - Country:US
Mailing Address - Phone:386-749-9449
Mailing Address - Fax:386-749-2280
Practice Address - Street 1:216 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:PIERSON
Practice Address - State:FL
Practice Address - Zip Code:32180-3024
Practice Address - Country:US
Practice Address - Phone:386-749-9449
Practice Address - Fax:386-749-2280
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96367207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276082700Medicaid
FLU8618XMedicare PIN
FL276082700Medicaid