Provider Demographics
NPI:1710910039
Name:ANDAVOLU, VANI BHAVANI (MD)
Entity Type:Individual
Prefix:
First Name:VANI
Middle Name:BHAVANI
Last Name:ANDAVOLU
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 1:19 LEGACY CT
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-9286
Mailing Address - Country:US
Mailing Address - Phone:609-651-2337
Mailing Address - Fax:609-964-1982
Practice Address - Street 1:99 ROUTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6423
Practice Address - Country:US
Practice Address - Phone:732-557-2270
Practice Address - Fax:732-557-2271
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05450300208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7227604Medicaid
NJ606122QQNMedicare PIN