1134514813 NPI number — NISHIKA MUDDASANI REDDY MD

Table of content: NISHIKA MUDDASANI REDDY MD (NPI 1134514813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134514813 NPI number — NISHIKA MUDDASANI REDDY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDDY
Provider First Name:
NISHIKA
Provider Middle Name:
MUDDASANI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MUDDASANI
Provider Other First Name:
NISHIKA
Provider Other Middle Name:
REDDY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134514813
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4445 LAKE FOREST DR
Provider Second Line Business Mailing Address:
STE 600
Provider Business Mailing Address City Name:
BLUE ASH
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45242-3744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-569-3741
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 OLENTANGY RIVER RD FL 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43212-3153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-293-8116
Provider Business Practice Location Address Fax Number:
614-293-4719
Provider Enumeration Date:
03/31/2015

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: 207W00000X , with the licence number:  35136562 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0358195 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".