Healthcare Provider Details

I. General information

NPI: 1568462570
Provider Name (Legal Business Name): SREEJAYA VELUVALI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 RIVERSIDE AVE
MINNEAPOLIS MN
55454-1450
US

IV. Provider business mailing address

6810 VALLEY VIEW RD
EDINA MN
55439-1646
US

V. Phone/Fax

Practice location:
  • Phone: 612-672-6600
  • Fax:
Mailing address:
  • Phone: 847-736-6624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036112021
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number49252
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: