Healthcare Provider Details

I. General information

NPI: 1750465811
Provider Name (Legal Business Name): ROY VELLANKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 E WASHINGTON ST STE 150
MEDINA OH
44256-3338
US

IV. Provider business mailing address

525 E MARKET ST PO BOX 2090
AKRON OH
44304-1619
US

V. Phone/Fax

Practice location:
  • Phone: 330-379-8145
  • Fax:
Mailing address:
  • Phone: 330-996-8603
  • Fax: 330-996-0359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35069031
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: