Provider Demographics
NPI:1861442840
Name:DEVABHAKTUNI, YASODA (MD)
Entity Type:Individual
Prefix:MRS
First Name:YASODA
Middle Name:
Last Name:DEVABHAKTUNI
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 1:2210 GREEN VALLEY RD
Mailing Address - Street 2:STE1
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4648
Mailing Address - Country:US
Mailing Address - Phone:812-945-4000
Mailing Address - Fax:812-945-0074
Practice Address - Street 1:2210 GREEN VALLEY RD
Practice Address - Street 2:STE1
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4648
Practice Address - Country:US
Practice Address - Phone:812-945-4000
Practice Address - Fax:812-945-0074
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059381A207RH0003X
KY35813207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200491310AMedicaid
IN200491310BMedicaid
IN200491310DMedicaid
IN200491310FMedicaid
IN196240HMedicare ID - Type Unspecified
IN200491310DMedicaid
IN200491310FMedicaid
IN731040HMedicare ID - Type Unspecified
IN209100DMedicare PIN