Healthcare Provider Details

I. General information

NPI: 1881148088
Provider Name (Legal Business Name): DEENA MALIREDDY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

750 HAMMOND DR STE 100
ATLANTA GA
30328-5532
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF340730
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: