Provider Demographics
NPI:1023859246
Name:GANDRA, SHRESTA REDDY (RBT)
Entity type:Individual
Prefix:
First Name:SHRESTA REDDY
Middle Name:
Last Name:GANDRA
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1664 MARKET PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7927
Mailing Address - Country:US
Mailing Address - Phone:470-253-4121
Mailing Address - Fax:470-299-7571
Practice Address - Street 1:1664 MARKET PLACE BLVD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7927
Practice Address - Country:US
Practice Address - Phone:470-253-4121
Practice Address - Fax:470-299-7571
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-24-323611106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician