Healthcare Provider Details

I. General information

NPI: 1992447015
Provider Name (Legal Business Name): VISHNU ADI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 NEW SCOTLAND RD #201
SLINGERLANDS NY
12159
US

IV. Provider business mailing address

17 DAVIS BLVD STE 308
TAMPA FL
33606-3438
US

V. Phone/Fax

Practice location:
  • Phone: 518-533-6550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number343252
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: