Provider Demographics
NPI:1760865497
Name:TIRUVEEDHULA, VEDAVANI (MD)
Entity Type:Individual
Prefix:
First Name:VEDAVANI
Middle Name:
Last Name:TIRUVEEDHULA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3 HOSPITAL PLZ
Mailing Address - Street 2:STE 302
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3095
Mailing Address - Country:US
Mailing Address - Phone:732-360-4077
Mailing Address - Fax:732-360-4078
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:APT 204
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-789-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2020-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2649582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry