Healthcare Provider Details

I. General information

NPI: 1043898331
Provider Name (Legal Business Name): DEEPTI VEDERE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEEPTI SHANBHAG VEDERE MD

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6445 N GREELEY AVE
PORTLAND OR
97217-5023
US

IV. Provider business mailing address

PO BOX 1517
PENDLETON OR
97801-0410
US

V. Phone/Fax

Practice location:
  • Phone: 503-285-6607
  • Fax: 503-285-3195
Mailing address:
  • Phone: 877-708-1119
  • Fax: 541-278-8349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD219116
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: