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General NPI Number Information
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NPI Number | 1720607260
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Entity Type | Individual
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Provider Name | MAYILATHAL VASUDEVAN NP
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Gender | Female
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 3140 PRINCETON PIKE FL 2
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-2330
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Country | US
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Telephone | 609-895-1919
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Fax | 609-895-2900
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Provider Business Mailing Address
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Address Line | 1 VACCARO RD
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-1324
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Country | US
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Telephone | 609-213-8902
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Fax |
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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 | 163WN0800X
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Taxonomy Name | Neuroscience Registered Nurse
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License Number | 26NRI4696700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ01240200
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License Number State | NJ
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