Healthcare Provider Details

I. General information

NPI: 1174878615
Provider Name (Legal Business Name): SUMAN VELLANKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N MAIN ST FL 6
AKRON OH
44310-3110
US

IV. Provider business mailing address

525 E MARKET ST
AKRON OH
44304-1619
US

V. Phone/Fax

Practice location:
  • Phone: 330-379-8190
  • Fax: 330-379-8191
Mailing address:
  • Phone: 330-379-8190
  • Fax: 330-379-8191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number35128080
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: