Nishitha Reddy Depa, M.D.

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

183 S Orange Ave
Behavioral Science Building E1452
Newark, NJ 07103

Phone

(973) 972-4670

NPI assigned

Apr 27, 2022

Reactivated

Mar 8, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mounika Reddy Depa Former name

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1651017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678233600000",
    "number": "1306580089",
    "addresses": [
        {
            "country_code": "CA",
            "country_name": "Canada",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "5 DAME GRUEV DRIVE",
            "city": "MARKHAM",
            "state": "ON",
            "postal_code": "LGE OM4"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "183 S ORANGE AVE",
            "address_2": "BEHAVIORAL SCIENCE BUILDING E1452",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "07103",
            "telephone_number": "973-972-4670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEPA",
        "first_name": "NISHITHA",
        "middle_name": "REDDY",
        "name_prefix": "Ms.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-27",
        "last_updated": "2023-03-08",
        "certification_date": "2023-03-08",
        "deactivation_date": "2023-01-30",
        "reactivation_date": "2023-03-08",
        "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": [
        {
            "first_name": "MOUNIKA",
            "last_name": "DEPA",
            "middle_name": "REDDY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Unknown Dennis, RD
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• Sarah Suzanne Deol, MD
• David A. Depaolis, D.C.
• Ariane Monique Chua Dequina, MSN, RN, NP-C, CMSRN
• Mariette Dermendjian, M.D.
• Jagrut Desai
• Karishma Desai, MD

• Student in an Organized Health Care Education/Training Program in Newark, NJ
• Providers in Newark, NJ by specialty
• Student in an Organized Health Care Education/Training Program in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.