Provider Demographics
NPI:1003202151
Name:VEDERE, TARUNYA REDDY
Entity Type:Individual
Prefix:
First Name:TARUNYA
Middle Name:REDDY
Last Name:VEDERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-8025
Mailing Address - Country:US
Mailing Address - Phone:860-679-3245
Mailing Address - Fax:860-679-0121
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-8025
Practice Address - Country:US
Practice Address - Phone:860-679-3245
Practice Address - Fax:860-679-0121
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT064927207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program