Healthcare Provider Details

I. General information

NPI: 1376477737
Provider Name (Legal Business Name): SIVA SANKAR REDDY GANGIREDDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST RM 5138
SYRACUSE NY
13210-1834
US

IV. Provider business mailing address

750 E ADAMS ST RM 5138
SYRACUSE NY
13210-1834
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-4478
  • Fax: 315-464-4484
Mailing address:
  • Phone: 315-464-4478
  • Fax: 315-464-4484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number341882
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: