Healthcare Provider Details

I. General information

NPI: 1144828104
Provider Name (Legal Business Name): SHILPA NARAHARI REDDY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N PATTERSON ST
VALDOSTA GA
31602-1785
US

IV. Provider business mailing address

2501 N PATTERSON ST
VALDOSTA GA
31602-1735
US

V. Phone/Fax

Practice location:
  • Phone: 229-333-1000
  • Fax:
Mailing address:
  • Phone: 229-333-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11009612
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number13981
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: