Healthcare Provider Details

I. General information

NPI: 1952891350
Provider Name (Legal Business Name): APEKSHA SAXENA-REDDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4941 BENCHMARK CENTRE DR STE 100
SWANSEA IL
62226-2038
US

IV. Provider business mailing address

4941 BENCHMARK CENTRE DR STE 100
SWANSEA IL
62226-2038
US

V. Phone/Fax

Practice location:
  • Phone: 618-624-9970
  • Fax: 618-624-9973
Mailing address:
  • Phone: 618-624-9970
  • Fax: 618-624-9973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036157031
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: