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NPI Code Detail

MEDICARE: VYSHNAVI PENDALA

MEDICARE: VYSHNAVI PENDALA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1093642126
Entity Type Code : Individual
Provider Name (Legal Business Name) : VYSHNAVI PENDALA
Provider Business Mailing Address
First Line : 1464 JEFFERSON ST N
Second Line :
City : LEWISBURG
State : WV
Zip : 24901-1380
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1464 JEFFERSON ST N
Second Line :
City : LEWISBURG
State : WV
Zip : 24901-1380
Country : US
Telephone Number : 304-645-3220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2026
Last Update Date : 05/05/2026

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Directions to “ VYSHNAVI PENDALA ” Practice Location

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