Healthcare Provider Details

I. General information

NPI: 1609511849
Provider Name (Legal Business Name): NIKHIL REDDY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST FL 6
DAYTON OH
45409-2932
US

IV. Provider business mailing address

30 E APPLE ST FL 6
DAYTON OH
45409-2939
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-2124
  • Fax:
Mailing address:
  • Phone: 937-208-2124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.079740
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35.152975
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: