Provider Demographics
NPI:1568971489
Name:INAMDAR, VEDALI SANTOSH
Entity Type:Individual
Prefix:
First Name:VEDALI
Middle Name:SANTOSH
Last Name:INAMDAR
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 1:800 S SUNSET AVE APT 395
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-5522
Mailing Address - Country:US
Mailing Address - Phone:352-745-9979
Mailing Address - Fax:
Practice Address - Street 1:410 E MERCED AVE STE E
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-5058
Practice Address - Country:US
Practice Address - Phone:352-745-9979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11557235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist