Healthcare Provider Details

I. General information

NPI: 1326993999
Provider Name (Legal Business Name): LIMA VADAKKEDAM APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 W BLACKWELL ST
DOVER NJ
07801-3841
US

IV. Provider business mailing address

18 W BLACKWELL ST
DOVER NJ
07801-3841
US

V. Phone/Fax

Practice location:
  • Phone: 973-328-3344
  • Fax: 973-328-7817
Mailing address:
  • Phone: 973-978-9154
  • Fax: 973-654-9855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15533500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR21336500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: