Healthcare Provider Details

I. General information

NPI: 1033371463
Provider Name (Legal Business Name): SURESH REDDY MEREDDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 116TH AVE NE STE F
BELLEVUE WA
98004-3801
US

IV. Provider business mailing address

13204 SE 306TH ST
AUBURN WA
98092-3278
US

V. Phone/Fax

Practice location:
  • Phone: 425-451-8417
  • Fax: 425-455-4089
Mailing address:
  • Phone: 914-409-6393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60194904
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberR75509
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number036.152855
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMD60194904
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: