Healthcare Provider Details

I. General information

NPI: 1255476107
Provider Name (Legal Business Name): SANJAY MUNIREDDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W 3RD AVE, STE. 410 PHOEBE SURGICAL ONCOLOGY
ALBANY GA
31701-1954
US

IV. Provider business mailing address

3010 FALLSTAFF MANOR CT APT D
BALTIMORE MD
21209-2823
US

V. Phone/Fax

Practice location:
  • Phone: 229-312-0707
  • Fax: 229-312-0705
Mailing address:
  • Phone: 813-390-2931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberP20960
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number070318
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: