Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 036114949 | IL |
N | 2080N0001X | Neonatal-Perinatal Doctor | N3613 | TX |
NPI | 1053471342 |
---|---|
Provider Name | Dr. Jennifer Reilly Desireddi |
First Address | Austin, TX 78705-1804 |
Second Address | Austin, TX 78705-1804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2006 |
Last Update Date | 28/11/2010 |