MEDICARE: NALINI REDDY LLC

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	2085R0202X	Diagnostic Radiology Physician	L3796	TX

General Provider Information

NPI Number	:	1740676816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NALINI REDDY LLC

Provider Business Mailing Address
First Line	:	9460 BELLA TERRA DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76126-1902
Country	:	US
Telephone Number	:	817-244-5685
Fax Number	:	817-244-5685

Provider Business Practice Location Address
First Line	:	9460 BELLA TERRA DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76126-1902
Country	:	US
Telephone Number	:	817-244-5685
Fax Number	:	817-244-5685

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	NALINI P REDDY
Credential	:	M.D
Telephone Number	:	817-244-5685

Provider Enumeration Date	:	04/15/2015
Last Update Date	:	04/15/2015

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