Provider Demographics
NPI:1801006325
Name:SELVARAJ, VITHYALAKSHMI (MBBS)
Entity Type:Individual
Prefix:
First Name:VITHYALAKSHMI
Middle Name:
Last Name:SELVARAJ
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7322 N 107 ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122
Mailing Address - Country:US
Mailing Address - Phone:402-889-3501
Mailing Address - Fax:
Practice Address - Street 1:601 N 30TH ST
Practice Address - Street 2:SUITE 5800
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2137
Practice Address - Country:US
Practice Address - Phone:402-280-4510
Practice Address - Fax:402-280-5792
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE256712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry