Provider Demographics
NPI:1679936512
Name:VEGUNTA, SRAVANTHI
Entity Type:Individual
Prefix:MISS
First Name:SRAVANTHI
Middle Name:
Last Name:VEGUNTA
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 1:11023 N SAINT ANDREWS WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4801
Mailing Address - Country:US
Mailing Address - Phone:309-303-2606
Mailing Address - Fax:
Practice Address - Street 1:11023 N SAINT ANDREWS WAY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4801
Practice Address - Country:US
Practice Address - Phone:309-303-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT10498736-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program