Provider Demographics
NPI:1538175146
Name:CHEVIREDDY, CHAITANYA (MD)
Entity type:Individual
Prefix:DR
First Name:CHAITANYA
Middle Name:
Last Name:CHEVIREDDY
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 1:333 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2719
Mailing Address - Country:US
Mailing Address - Phone:631-789-2020
Mailing Address - Fax:
Practice Address - Street 1:333 BROADWAY
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2719
Practice Address - Country:US
Practice Address - Phone:631-789-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234398207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI25630Medicare UPIN
NY081SH1Medicare ID - Type UnspecifiedEMPIRE