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General NPI Number Information
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NPI Number | 1073492278
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Entity Type | Organization
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Legal Business Name | VITALITY HEALTH PARTNERS PLLC
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Dates
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Enumeration Date | 09/01/2025
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Last Update Date | 09/01/2025
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Provider Practice Location Address
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Address Line | 101 COOPERATIVE WAY STE 405
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City | GEORGETOWN
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State | TX
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Zip | 78626-8208
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Country | US
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Telephone | 979-571-5749
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Fax |
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Provider Business Mailing Address
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Address Line | 3515 LONGMIRE DR STE B120
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City | COLLEGE STATION
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State | TX
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Zip | 77845-5489
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. SHANKAR BELLAM
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Credential |
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Telephone | 979-571-5749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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