Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 25MA07999700 | NJ |
N | 2084N0402X | Child Neurologist | 25MA07999700 | NJ |
N | 2084N0600X | Clinical Neurophysiologist | 25MA07999700 | NJ |
NPI | 1033310404 |
---|---|
Provider Name | Kavitha Velicheti |
First Address | Edison, NJ 08818 |
Second Address | Edison, NJ 08818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 02/11/2007 |