MEDICARE: DR. SOWMINI KOMMIREDDI

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	208000000X	Pediatrics Physician	25MA073809	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518064260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOWMINI KOMMIREDDI

Provider Business Mailing Address
First Line	:	719 N BEERS ST STE 1E
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1523
Country	:	US
Telephone Number	:	732-739-4414
Fax Number	:	732-739-9537

Provider Business Practice Location Address
First Line	:	719 N BEERS ST STE 1E
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1523
Country	:	US
Telephone Number	:	732-739-4414
Fax Number	:	732-739-9537

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

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	06/09/2026

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Directions to “ DR. SOWMINI KOMMIREDDI ” Practice Location

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