Healthcare Provider Details

I. General information

NPI: 1518064260
Provider Name (Legal Business Name): DR. SOWMINI KOMMIREDDI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 N BEERS ST STE 1E
HOLMDEL NJ
07733-1523
US

IV. Provider business mailing address

719 N BEERS ST STE 1E
HOLMDEL NJ
07733-1523
US

V. Phone/Fax

Practice location:
  • Phone: 732-739-4414
  • Fax: 732-739-9537
Mailing address:
  • Phone: 732-739-4414
  • Fax: 732-739-9537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA073809
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: