Provider Demographics
NPI:1134432479
Name:REDDY REDDY, SUPRAJA REDDY (MD)
Entity type:Individual
Prefix:
First Name:SUPRAJA
Middle Name:REDDY
Last Name:REDDY REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11155 DUNN RD STE 109N
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6148
Mailing Address - Country:US
Mailing Address - Phone:314-953-8799
Mailing Address - Fax:314-953-8798
Practice Address - Street 1:11155 DUNN RD STE 109N
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6148
Practice Address - Country:US
Practice Address - Phone:314-953-8799
Practice Address - Fax:314-953-8798
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036141805207RE0101X
MO2014004832207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism