Provider Demographics
NPI:1730262478
Name:BOYAREDDYGARI, SUNEEL (MD)
Entity type:Individual
Prefix:DR
First Name:SUNEEL
Middle Name:
Last Name:BOYAREDDYGARI
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 1:90 MADISON STREET
Mailing Address - Street 2:STE 504
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206
Mailing Address - Country:US
Mailing Address - Phone:720-524-1550
Mailing Address - Fax:720-524-1551
Practice Address - Street 1:1619 N GREENWOOD
Practice Address - Street 2:STE 204
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003
Practice Address - Country:US
Practice Address - Phone:719-544-1551
Practice Address - Fax:719-544-1493
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241472174400000X
CO45217207R00000X
KY42057207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20705590Medicaid
CO20705590Medicaid