Basic Information
| Provider Information | |||||||||
| NPI: | 1831681865 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEMAKALLU | ||||||||
| FirstName: | SHARANYA REDDY | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | ONE BROOKDALE PLAZA | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182405000 | ||||||||
| FaxNumber: | 7182406738 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE BROOKDALE PLAZA | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182405000 | ||||||||
| FaxNumber: | 7182406738 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2018 | ||||||||
| LastUpdateDate: | 07/17/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 01/25/2019 | ||||||||
| NPIReactivationDate: | 07/17/2019 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.