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General NPI Number Information
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NPI Number | 1861621369
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Entity Type | Individual
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Provider Name | DEEPTHI VENKAT BYREDDY M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/07/2009
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 1650 COCHRANE CIR
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City | FORT CARSON
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State | CO
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Zip | 80913-4613
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Country | US
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Telephone | 719-526-7632
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Fax | 719-503-7233
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Provider Business Mailing Address
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Address Line | 1650 COCHRANE CIR
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City | FORT CARSON
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State | CO
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Zip | 80913-4613
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Country | US
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Telephone | 719-526-7632
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | RS2009-0372
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MT193378
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | MD2011-0564
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License Number State | NM
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