Provider Demographics
NPI:1861762114
Name:REDDY, ANJALI GADDAM (NP)
Entity type:Individual
Prefix:
First Name:ANJALI
Middle Name:GADDAM
Last Name:REDDY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANJALI
Other - Middle Name:REDDY
Other - Last Name:GADDAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:9303 PINECROFT DR
Mailing Address - Street 2:SUITE 340
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3181
Mailing Address - Country:US
Mailing Address - Phone:281-681-0616
Mailing Address - Fax:281-419-0445
Practice Address - Street 1:9303 PINECROFT DR
Practice Address - Street 2:SUITE 340
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-3181
Practice Address - Country:US
Practice Address - Phone:281-681-0616
Practice Address - Fax:281-419-0445
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX577483363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158998802Medicaid
TX158998802Medicaid