Provider Demographics
NPI:1629121447
Name:SAMAVEDY, NALINI (MD)
Entity Type:Individual
Prefix:
First Name:NALINI
Middle Name:
Last Name:SAMAVEDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 DOWELL SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2441
Mailing Address - Country:US
Mailing Address - Phone:865-374-7123
Mailing Address - Fax:865-374-7129
Practice Address - Street 1:210 SIMMONS ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-4750
Practice Address - Country:US
Practice Address - Phone:865-970-9800
Practice Address - Fax:865-374-7129
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI506410202084P0800X
TN435682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34920300Medicaid
TN1509802Medicaid
TN3002480Medicare PIN
WI847670086Medicare PIN