Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 29267 | NE |
NPI | 1003189440 |
---|---|
Provider Name | Swetha Pedavally |
First Address | Omaha, NE 68198-8102 |
Second Address | Omaha, NE 68131-2813 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2012 |
Last Update Date | 17/03/2018 |