Healthcare Provider Details

I. General information

NPI: 1760129654
Provider Name (Legal Business Name): SHREYA BOOJALA REDDY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 STANTON L YOUNG BLVD
OKLAHOMA CITY OK
73104-5036
US

IV. Provider business mailing address

920 STANTON L YOUNG BLVD
OKLAHOMA CITY OK
73104-5036
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4351
  • Fax:
Mailing address:
  • Phone: 920-114-0731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number47834
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10080357
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: