Healthcare Provider Details

I. General information

NPI: 1225608094
Provider Name (Legal Business Name): VENKATA SIVA SUDHAKAR REDDY LOKIREDDY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 OLD NATIONAL PIKE
FREDERICKTOWN PA
15333-2114
US

IV. Provider business mailing address

1070 OLD NATIONAL PIKE
FREDERICKTOWN PA
15333-2114
US

V. Phone/Fax

Practice location:
  • Phone: 724-632-6801
  • Fax: 724-632-6312
Mailing address:
  • Phone: 724-632-6801
  • Fax: 724-632-6312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD489418
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: