Healthcare Provider Details

I. General information

NPI: 1265746994
Provider Name (Legal Business Name): SHIVANI REDDY KANDUKURI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

200 S MANCHESTER AVE
ORANGE CA
92868-3217
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8888
  • Fax:
Mailing address:
  • Phone: 174-456-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberA127205
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberA127205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: