Healthcare Provider Details

I. General information

NPI: 1427394782
Provider Name (Legal Business Name): REDDY FOOT AND ANKLE CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 VALLEY FORGE RD
WORCESTER PA
19490
US

IV. Provider business mailing address

2060 VALLEY FORGE RD
WORCESTER PA
19490
US

V. Phone/Fax

Practice location:
  • Phone: 610-584-8009
  • Fax: 610-584-8679
Mailing address:
  • Phone: 610-584-8009
  • Fax: 610-584-8679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License NumberSC006228
License Number StatePA

VIII. Authorized Official

Name: SUNEETA SIDDAPUREDDY
Title or Position: PRESIDENT
Credential: DPM
Phone: 248-470-2311