Healthcare Provider Details

I. General information

NPI: 1063265908
Provider Name (Legal Business Name): DR. LAVANYA GOVINDASAMY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 04/10/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EAST VIRGINIA MEDICAL SCHOOL, EVMS PEDIATRICS 601, CHILDREN'S LANE
NORFOLK VA
23507-9982
US

IV. Provider business mailing address

14131 TRAVIS ST APT 801
OVERLAND PARK KS
66223-4808
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7249
  • Fax:
Mailing address:
  • Phone: 408-909-2331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: