Healthcare Provider Details

I. General information

NPI: 1174192207
Provider Name (Legal Business Name): ANUSHA REDDY GADDAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 03/13/2025
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 BEECHTREE DR SUITE 1120
SANFORD NC
27330-6934
US

IV. Provider business mailing address

2919 BEECHTREE DR SUITE 1120
SANFORD NC
27330-6934
US

V. Phone/Fax

Practice location:
  • Phone: 919-897-2256
  • Fax: 919-897-2261
Mailing address:
  • Phone: 919-897-2256
  • Fax: 919-897-2261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2024-01025
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: