Healthcare Provider Details

I. General information

NPI: 1831681865
Provider Name (Legal Business Name): SHARANYA REDDY NEMAKALLU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date: 01/25/2019
Reactivation Date: 07/17/2019

III. Provider practice location address

40 MITCHELL AVE, FL 3
BINGHAMTON NY
13903
US

IV. Provider business mailing address

ONE BROOKDALE PLAZA
BROOKLYN NY
11212
US

V. Phone/Fax

Practice location:
  • Phone: 607-772-0639
  • Fax:
Mailing address:
  • Phone: 718-240-5000
  • Fax: 718-240-6738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number343577
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: