Basic Information
| Provider Information | |||||||||
| NPI: | 1811243041 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NANJIREDDY | ||||||||
| FirstName: | PRIYANKA | ||||||||
| MiddleName: | MARIDHI | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | ROSWELL PARK/OISHEI CHILDREN'S CANCER AND BLOOD DISORDE | ||||||||
| Address2: | 685 ELM STREET | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168452333 | ||||||||
| FaxNumber: | 7168458003 | ||||||||
| Practice Location | |||||||||
| Address1: | ROSWELL PARK/OISHEI CHILDREN'S CANCER AND BLOOD DISORDE | ||||||||
| Address2: | 685 ELM STREET | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168452333 | ||||||||
| FaxNumber: | 7168458003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2012 | ||||||||
| LastUpdateDate: | 09/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A144022 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.