Healthcare Provider Details

I. General information

NPI: 1750576898
Provider Name (Legal Business Name): VIVEK VELUCHAMY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4186 HOLIDAY ST NW
CANTON OH
44718-2532
US

IV. Provider business mailing address

4186 HOLIDAY ST NW
CANTON OH
44718-2532
US

V. Phone/Fax

Practice location:
  • Phone: 330-288-7006
  • Fax: 844-689-3503
Mailing address:
  • Phone: 330-288-7006
  • Fax: 844-689-3503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35093218
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35.093218
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number35093218
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: