Healthcare Provider Details

I. General information

NPI: 1972998045
Provider Name (Legal Business Name): AVANISH SURASANI REDDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2015
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 J ST
SACRAMENTO CA
95819-3626
US

IV. Provider business mailing address

5893 BROOKSHIRE DR
ROCKLIN CA
95677-3297
US

V. Phone/Fax

Practice location:
  • Phone: 315-725-6141
  • Fax:
Mailing address:
  • Phone: 315-725-6141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number298730
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA180537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: