Healthcare Provider Details

I. General information

NPI: 1083268478
Provider Name (Legal Business Name): SNIGDHA GADIREDDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 W 43RD AVE STE A
PINE BLUFF AR
71603-7010
US

IV. Provider business mailing address

PO BOX 2650
PINE BLUFF AR
71613-2650
US

V. Phone/Fax

Practice location:
  • Phone: 870-541-6015
  • Fax: 870-541-6016
Mailing address:
  • Phone: 870-541-7211
  • Fax: 870-541-4297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberE-17892
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: