Healthcare Provider Details

I. General information

NPI: 1265597033
Provider Name (Legal Business Name): INFECTIOUS DISEASES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 LEXINGTON AVE SUITE 100
ASHLAND KY
41101-2873
US

IV. Provider business mailing address

2301 LEXINGTON AVE SUITE 100
ASHLAND KY
41101-2873
US

V. Phone/Fax

Practice location:
  • Phone: 606-325-0011
  • Fax:
Mailing address:
  • Phone: 606-325-0011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number40111
License Number StateKY

VIII. Authorized Official

Name: SHAILAJA VELIGANDLA
Title or Position: OWNER
Credential: M.D.
Phone: 606-325-0011