MEDICARE: DR. PRAMEELA VASIREDDY

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
1	1223G0001X	General Practice Dentistry	18824	OH

General Provider Information

NPI Number	:	1447298864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRAMEELA VASIREDDY

Provider Business Mailing Address
First Line	:	2717 S ARLINGTON RD
Second Line	:	SUITE F
City	:	AKRON
State	:	OH
Zip	:	44312-4725
Country	:	US
Telephone Number	:	330-644-7911
Fax Number	:	330-644-5491

Provider Business Practice Location Address
First Line	:	2717 S ARLINGTON RD
Second Line	:	SUITE F
City	:	AKRON
State	:	OH
Zip	:	44312-4725
Country	:	US
Telephone Number	:	330-644-7911
Fax Number	:	330-644-5491

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	07/08/2007

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