Healthcare Provider Details

I. General information

NPI: 1073596276
Provider Name (Legal Business Name): PRIYA A YELLAYI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PRIYA AKELLA M.D

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 03/07/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE NAVAL HOSPITAL CAMP PENDLETON
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

1075 STEPHENSON AVENUE PATTERSON ARMY HEALTH CLINIC
FORT MONMOUTH NJ
07703-5000
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1048
  • Fax:
Mailing address:
  • Phone: 732-532-0182
  • Fax: 732-532-0194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA53970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: