Provider Demographics
NPI:1548014822
Name:BOOREDDY, SATHWIK (MD)
Entity type:Individual
Prefix:DR
First Name:SATHWIK
Middle Name:
Last Name:BOOREDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-1005 MOANALUA RD SPC 3030
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4735
Mailing Address - Country:US
Mailing Address - Phone:650-483-8584
Mailing Address - Fax:
Practice Address - Street 1:98-1005 MOANALUA RD SPC 3030
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4735
Practice Address - Country:US
Practice Address - Phone:650-483-8584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMDR-8736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine