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General NPI Number Information
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NPI Number | 1922808419
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Entity Type | Individual
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Provider Name | VENKATESHWARLU KAMISHETTY MD
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Gender | Male
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Dates
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Enumeration Date | 03/14/2025
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 9131 175TH ST
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City | JAMAICA
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State | NY
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Zip | 11432-5517
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Country | US
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Telephone | 718-657-6363
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Fax |
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Provider Business Mailing Address
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Address Line | 3438 BELL BLVD STE 301
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City | BAYSIDE
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State | NY
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Zip | 11361-1739
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Country | US
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Telephone | 187-709-0940
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | P133137
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License Number State | NY
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