Provider Demographics
NPI:1376168567
Name:VADAKKEVEEDU, SIDDHARTH JAYASANKAR (DO)
Entity Type:Individual
Prefix:
First Name:SIDDHARTH
Middle Name:JAYASANKAR
Last Name:VADAKKEVEEDU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 ROBERTS WAY
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2063
Mailing Address - Country:US
Mailing Address - Phone:919-995-2335
Mailing Address - Fax:
Practice Address - Street 1:42 E LAUREL RD STE 3100
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1354
Practice Address - Country:US
Practice Address - Phone:856-566-2753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program