Provider Demographics
NPI:1548490428
Name:ONTEDDU, SANJEEVA REDDY (MD)
Entity type:Individual
Prefix:DR
First Name:SANJEEVA REDDY
Middle Name:
Last Name:ONTEDDU
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 1:508 GAMBLE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3210
Mailing Address - Country:US
Mailing Address - Phone:609-865-0813
Mailing Address - Fax:
Practice Address - Street 1:508 GAMBLE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3210
Practice Address - Country:US
Practice Address - Phone:609-865-0813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-25
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-84522084N0400X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology