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General NPI Number Information
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NPI Number | 1700048501
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Entity Type | Individual
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Provider Name | GEETHA GANTI VEDULA MD
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Gender | Female
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 1776 N PINE ISLAND RD STE 214
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City | PLANTATION
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State | FL
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Zip | 33322
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Country | US
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Telephone | 310-206-1166
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Fax | 310-301-8713
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Provider Business Mailing Address
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Address Line | 1776 N PINE ISLAND RD STE 214
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City | PLANTATION
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State | FL
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Zip | 33322-5223
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Country | US
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Telephone | 954-452-9922
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Fax | 954-452-7574
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A108911
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME107675
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License Number State | FL
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