Healthcare Provider Details

I. General information

NPI: 1720459381
Provider Name (Legal Business Name): RISHITHA YELISETTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 06/09/2022
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 MALL RING CIR STE 202
HENDERSON NV
89014-6667
US

IV. Provider business mailing address

715 MALL RING CIR STE 202
HENDERSON NV
89014-6667
US

V. Phone/Fax

Practice location:
  • Phone: 702-483-6200
  • Fax: 702-483-6202
Mailing address:
  • Phone: 702-483-6200
  • Fax: 702-483-6202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number21020
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number21020
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21020
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA10772300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: