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General NPI Number Information
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NPI Number | 1295774305
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Entity Type | Individual
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Provider Name | SHYLA REDDY MD
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Gender | Female
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 480 N MAIN ST STE 202
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City | ALPHARETTA
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State | GA
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Zip | 30009-8386
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Country | US
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Telephone | 678-619-1974
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Fax | 678-619-1975
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Provider Business Mailing Address
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Address Line | PO BOX 1385 P O BOX 1385
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City | ALPHARETTA
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State | GA
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Zip | 30009-1385
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Country | US
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Telephone | 678-619-1974
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Fax | 678-619-1975
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 25425
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 71622
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License Number State | GA
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