Healthcare Provider Details

I. General information

NPI: 1154596567
Provider Name (Legal Business Name): SUNEETHA VYSETTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2008
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 OGDEN AVE STE 401
AURORA IL
60504-7208
US

IV. Provider business mailing address

2040 OGDEN AVE STE 401
AURORA IL
60504-7208
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-4889
  • Fax: 630-978-4913
Mailing address:
  • Phone: 630-978-4889
  • Fax: 630-978-4913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125051863
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number036124844
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: