Healthcare Provider Details

I. General information

NPI: 1659186062
Provider Name (Legal Business Name): DEVANGI VACHHANI RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 HAPPY HOLLOW RD APT D11
WEST LAFAYETTE IN
47906-1722
US

IV. Provider business mailing address

2410 HAPPY HOLLOW RD APT D11
WEST LAFAYETTE IN
47906-1722
US

V. Phone/Fax

Practice location:
  • Phone: 732-407-2148
  • Fax:
Mailing address:
  • Phone: 732-407-2148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB889902
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: