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General NPI Number Information
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NPI Number | 1609036771
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Entity Type | Individual
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Provider Name | INNA V VELYCHKO M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 9300 SE 91ST AVE STE 201
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City | PORTLAND
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State | OR
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Zip | 97086-3762
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Country | US
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Telephone | 503-387-7111
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Fax | 503-567-7706
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Provider Business Mailing Address
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Address Line | PO BOX 226
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City | BRUSH PRAIRIE
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State | WA
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Zip | 98606-0226
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Country | US
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Telephone | 503-387-7111
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Fax | 971-288-1045
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 57.012943
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD183825
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD60155804
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License Number State | WA
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