Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 041901-1 | NY |
Y | 213ES0000X | Sports Medicine | 041901-1 | NY |
NPI | 1518504646 |
---|---|
Provider Name | Mrs. Dheeraja Reddy Byreddy |
First Address | Stony Point, NY 10980-1919 |
Second Address | Stony Point, NY 10980-1919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2019 |
Last Update Date | 09/12/2019 |