MEDICARE: MR. ROY VELLANKI MD

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	2084P0800X	Psychiatry Physician	35069031	OH

General Provider Information

NPI Number	:	1750465811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROY VELLANKI MD

Provider Business Mailing Address
First Line	:	525 E MARKET ST
Second Line	:	PO BOX 2090
City	:	AKRON
State	:	OH
Zip	:	44304-1619
Country	:	US
Telephone Number	:	330-996-8603
Fax Number	:	330-996-0359

Provider Business Practice Location Address
First Line	:	807 E WASHINGTON ST
Second Line	:	STE 150
City	:	MEDINA
State	:	OH
Zip	:	44256-3338
Country	:	US
Telephone Number	:	330-379-8145
Fax Number	:

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	01/25/2013

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