MEDICARE: DR. SHASHIDHAR SADDA REDDY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	MA07934600	NJ

General Provider Information

NPI Number	:	1285625582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHASHIDHAR SADDA REDDY MD

Provider Business Mailing Address
First Line	:	PO BOX 416457
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-6457
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	89 SPARTA AVE
Second Line	:	SUITE 220
City	:	SPARTA
State	:	NJ
Zip	:	07871-1777
Country	:	US
Telephone Number	:	973-940-8100
Fax Number	:	973-729-7235

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	01/11/2019

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