Basic Information
| Provider Information | |||||||||
| NPI: | 1104339910 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANNAREDDY | ||||||||
| FirstName: | SWETHA | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3323 FARMGATE DR | ||||||||
| Address2: | |||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605645930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175219414 | ||||||||
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| Practice Location | |||||||||
| Address1: | 115 E SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605451417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305527166 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 085006315 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.