1801258207 NPI number — DR. SHRENIKA GUNUKULA REDDY M.D.

Table of content: DR. HARNATH SINGH M.D. (NPI 1538133236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801258207 NPI number — DR. SHRENIKA GUNUKULA REDDY M.D.

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EDLA
Provider Other First Name:
SRI SHRENIKA SHOURIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.B.B.S.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801258207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 US HIGHWAY 61 STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FESTUS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63028-4141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-933-8880
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 US HIGHWAY 61 STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FESTUS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63028-4141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-933-8880
Provider Business Practice Location Address Fax Number:
636-933-8881
Provider Enumeration Date:
03/24/2016

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: 207RE0101X , with the licence number:  2021046251 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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