Healthcare Provider Details

I. General information

NPI: 1518802065
Provider Name (Legal Business Name): ADITHYA ANDANAPPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PRIME WEST CONSORTIUM/SHASTA REGIONAL MEDICAL CENTER, 1100 BUTTE STREET
REDDING CA
96001
US

IV. Provider business mailing address

PRIME WEST CONSORTIUM/SHASTA REGIONAL MEDICAL CENTER, 1100 BUTTE STEET
REDDING CA
96001-0852
US

V. Phone/Fax

Practice location:
  • Phone: 530-244-8250
  • Fax: 530-244-5494
Mailing address:
  • Phone: 530-244-8250
  • Fax: 530-244-5494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: