Provider Demographics
NPI:1598149676
Name:KHALSA, DEVA (VMD)
Entity Type:Individual
Prefix:DR
First Name:DEVA
Middle Name:
Last Name:KHALSA
Suffix:
Gender:F
Credentials:VMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 YARDLEY LANGHORNE RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5517
Mailing Address - Country:US
Mailing Address - Phone:215-550-4474
Mailing Address - Fax:727-608-4499
Practice Address - Street 1:1560 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-2152
Practice Address - Country:US
Practice Address - Phone:215-550-4474
Practice Address - Fax:727-608-4499
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABV005058L174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian