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General NPI Number Information
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NPI Number | 1962760777
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Entity Type | Individual
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Provider Name | KAVYA EDAVALLY REDDY MD
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Gender | Female
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 04/03/2018
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Provider Practice Location Address
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Address Line | 3000 NEW BERN AVE
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City | RALEIGH
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State | NC
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Zip | 27610-1231
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Country | US
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Telephone | 919-350-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 SITUS CT STE 170
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City | RALEIGH
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State | NC
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Zip | 27606-4279
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Country | US
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Telephone | 919-834-2767
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Fax | 919-834-0234
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2018-00612
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License Number State | NC
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Taxonomy #2
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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 |
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