Provider Demographics
NPI:1578040317
Name:NAGIREDDI, LAKSHMI SATYA SUPRIYA (DO)
Entity type:Individual
Prefix:
First Name:LAKSHMI SATYA
Middle Name:SUPRIYA
Last Name:NAGIREDDI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 HIGHGATE DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4097
Mailing Address - Country:US
Mailing Address - Phone:636-236-3063
Mailing Address - Fax:
Practice Address - Street 1:1600 S ANDREWS AVE # GME
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:954-459-2091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO6296390200000X
OH34.015583207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program