Healthcare Provider Details

I. General information

NPI: 1245381896
Provider Name (Legal Business Name): VIJITHA REDDY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 W FAIRBANKS AVE
WINTER PARK FL
32789-4721
US

IV. Provider business mailing address

9582 W COLONIAL DR
OCOEE FL
34761-6992
US

V. Phone/Fax

Practice location:
  • Phone: 407-629-7474
  • Fax: 407-629-7475
Mailing address:
  • Phone: 407-363-6700
  • Fax: 407-363-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME80136
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: