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General NPI Number Information
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NPI Number | 1558229195
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Entity Type | Individual
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Provider Name | MOUNICA REDDY GAYAM
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Gender | Female
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Dates
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Enumeration Date | 01/13/2026
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 6111 S CEDAR ST
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City | LANSING
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State | MI
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Zip | 48911-5714
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Country | US
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Telephone | 517-393-3447
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Fax |
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Provider Business Mailing Address
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Address Line | 4288 HUNTERS CIR W
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City | CANTON
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State | MI
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Zip | 48188-2365
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Country | US
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Telephone | 734-747-3476
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | MI
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