Healthcare Provider Details

I. General information

NPI: 1447606488
Provider Name (Legal Business Name): BRINDA MANCHIREDDY M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 SAM PERRY BLVD #305
FREDRICKSBURG VA
22401
US

IV. Provider business mailing address

1101 SAM PERRY BLVD #305
FREDRICKSBURG VA
22401
US

V. Phone/Fax

Practice location:
  • Phone: 540-374-3290
  • Fax: 540-374-3289
Mailing address:
  • Phone: 540-374-3290
  • Fax: 540-374-3289

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 State
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number0101271645
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: