Healthcare Provider Details

I. General information

NPI: 1811372733
Provider Name (Legal Business Name): DEVI SAMEERA TAMMINEEDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W CHARLESTON BLVD SUITE 230
LAS VEGAS NV
89102-2325
US

IV. Provider business mailing address

4755 OGLETOWN STANTON RD STE 5A43
NEWARK DE
19718-2200
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-2358
  • Fax: 702-671-2376
Mailing address:
  • Phone: 302-623-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC1-00127
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: