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General NPI Number Information
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NPI Number | 1902383433
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Entity Type | Individual
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Provider Name | MONA VIJAY VELLANKI MD
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Gender | Female
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Dates
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Enumeration Date | 07/26/2018
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 530 NEW BRUNSWICK AVE
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City | PERTH AMBOY
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State | NJ
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Zip | 08861-3685
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Country | US
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Telephone | 732-442-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 3802 CHARLESTON DR
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City | MONROE
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State | NJ
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Zip | 08831-3351
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Country | US
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Telephone | 201-850-3114
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 25MA10865400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA10865400
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License Number State | NJ
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