Healthcare Provider Details

I. General information

NPI: 1417311051
Provider Name (Legal Business Name): PRATHYUSHA REDDY YETURU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2016
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102-10 66TH ROAD SUITE 1G
FOREST HILLS NY
11375
US

IV. Provider business mailing address

102-10 66TH ROAD SUITE 1G
FOREST HILLS NY
11375
US

V. Phone/Fax

Practice location:
  • Phone: 718-806-1434
  • Fax: 718-806-1435
Mailing address:
  • Phone: 718-806-1434
  • Fax: 718-806-1435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number300986
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: