Healthcare Provider Details

I. General information

NPI: 1982523155
Provider Name (Legal Business Name): HIMAJA REDDY SAMIREDDY MED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7022 SARDIS RD
CHARLOTTE NC
28270-6058
US

IV. Provider business mailing address

10213 KENDRA CT
CHARLOTTE NC
28277-3172
US

V. Phone/Fax

Practice location:
  • Phone: 704-366-8260
  • Fax:
Mailing address:
  • Phone: 732-788-7009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB1173879
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number4544
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: