Individual
JAYA REDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1540 SUNDAY DR, RALEIGH, NC 27607-6010
(919) 420-1653
(919) 788-8519
Mailing address
3000 NEW BERN AVE, RALEIGH, NC 27610-1231
(919) 782-3456
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
102710
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0167G
BCBSNC
NC
01
—
2625004
UHC
NC
01
—
91933
MEDCOST
NC
Enumeration date
10/03/2006
Last updated
04/09/2009
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