Healthcare Provider Details

I. General information

NPI: 1912101338
Provider Name (Legal Business Name): NITA VELLODY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 INTERNATIONAL WAY
SPRINGFIELD OR
97477-6013
US

IV. Provider business mailing address

555 INTERNATIONAL WAY
SPRINGFIELD OR
97477-6013
US

V. Phone/Fax

Practice location:
  • Phone: 458-544-0400
  • Fax: 541-255-2797
Mailing address:
  • Phone: 458-544-0400
  • Fax: 541-255-2797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO152484
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: