1649236431 NPI number — DR. DINDI D REDDY M.D.

Table of content: DR. DINDI D REDDY M.D. (NPI 1649236431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649236431 NPI number — DR. DINDI D REDDY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDDY
Provider First Name:
DINDI
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649236431
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 WINDERLEY PL
Provider Second Line Business Mailing Address:
SUITE 2100
Provider Business Mailing Address City Name:
MAITLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32751-7267
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-200-2355
Provider Business Mailing Address Fax Number:
407-303-0893

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 E ROLLINS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32803-1248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-200-2355
Provider Business Practice Location Address Fax Number:
407-303-0893
Provider Enumeration Date:
04/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  ME0094620 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 57155 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 274825800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 018866600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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