Healthcare Provider Details

I. General information

NPI: 1285613133
Provider Name (Legal Business Name): DEVENDER N AKULA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ENGLISH CREEK AVE. BLDG 200, STE 211
EGG HARBOR TOWNSHIP NJ
08234
US

IV. Provider business mailing address

2500 ENGLISH CREEK AVE. BLDG 200, STE 211
EGG HARBOR TOWNSHIP NJ
08234
US

V. Phone/Fax

Practice location:
  • Phone: 609-677-7776
  • Fax: 609-677-7509
Mailing address:
  • Phone: 609-677-7776
  • Fax: 856-428-5748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA07142700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number25MA07142700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: