Provider Demographics
NPI:1023181138
Name:SIVAREDDY, SAILAJA (MD)
Entity type:Individual
Prefix:
First Name:SAILAJA
Middle Name:
Last Name:SIVAREDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAILAJA
Other - Middle Name:
Other - Last Name:ADAPALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14724 VILLAGE RD
Mailing Address - Street 2:SUITE # GB
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-6348
Mailing Address - Country:US
Mailing Address - Phone:718-715-1764
Mailing Address - Fax:718-885-9311
Practice Address - Street 1:8924 146TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3640
Practice Address - Country:US
Practice Address - Phone:718-715-1764
Practice Address - Fax:718-885-9311
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241662207R00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02869107Medicaid
NYG300055970Medicare PIN