Provider Demographics
NPI:1992871032
Name:REDDY, SUMATHY (MD, FAAFP)
Entity type:Individual
Prefix:DR
First Name:SUMATHY
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD, FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 BARNARD AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2709
Mailing Address - Country:US
Mailing Address - Phone:516-223-3117
Mailing Address - Fax:516-431-1179
Practice Address - Street 1:871 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2709
Practice Address - Country:US
Practice Address - Phone:516-223-3117
Practice Address - Fax:516-431-1179
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145530174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY145530OtherLICENSE NUMBER
NY00720829Medicaid
NYAR1048304OtherDEA NUMBER
NY00720829Medicaid
NYAR1048304OtherDEA NUMBER