Healthcare Provider Details

I. General information

NPI: 1972691590
Provider Name (Legal Business Name): VIJAYA V. VELLANKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WARD AVE SUITE 840
HONOLULU HI
96814-1600
US

IV. Provider business mailing address

1100 WARD AVE SUITE 840
HONOLULU HI
96814-1600
US

V. Phone/Fax

Practice location:
  • Phone: 808-522-4521
  • Fax: 808-522-3526
Mailing address:
  • Phone: 808-522-4521
  • Fax: 808-522-3526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-12326
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: