Healthcare Provider Details

I. General information

NPI: 1366905499
Provider Name (Legal Business Name): SIRISH VELIGATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2019
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 STOCKTON BLVD
SACRAMENTO CA
95817-1353
US

IV. Provider business mailing address

2230 STOCKTON BLVD
SACRAMENTO CA
95817-1353
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3574
  • Fax: 916-734-0849
Mailing address:
  • Phone: 916-734-5514
  • Fax: 916-734-3384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number180574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: