Individual provider Active NPI

Gayathri Reddy Kanmantha Reddy

  • Student in an Organized Health Care Education/Training Program
  • Detroit, MI
National Provider Identifier
1164367769
Registry record updated Apr 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
22201 Moross Rd Ste 50
Detroit, MI 48236-2166
Phone
(313) 343-7774
Fax
(313) 343-8747
NPI assigned
Apr 21, 2026
Last updated
Apr 21, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 21, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

22201 Moross Rd Ste 50
Detroit, MI 48236-2166

Mailing address

3960 Shallow Brook Dr
Bloomfield Hills, MI 48302-1561
Phone (248) 296-9108

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1776729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776729600000",
    "number": "1164367769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3960 SHALLOW BROOK DR",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483021561",
            "telephone_number": "248-296-9108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22201 MOROSS RD STE 50",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362166",
            "telephone_number": "313-343-7774",
            "fax_number": "313-343-8747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANMANTHA REDDY",
        "first_name": "GAYATHRI REDDY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-04-21",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.