Provider Demographics
NPI:1740568914
Name:HEERAMUN, VINEKA
Entity Type:Individual
Prefix:
First Name:VINEKA
Middle Name:
Last Name:HEERAMUN
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 1:13894 S BANGERTER PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5320
Mailing Address - Country:US
Mailing Address - Phone:801-618-4303
Mailing Address - Fax:
Practice Address - Street 1:8846 S REDWOOD RD STE N202
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-4702
Practice Address - Country:US
Practice Address - Phone:801-618-4303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT96038962084P0800X, 207R00000X
IL1250603062084P0800X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine