Provider Demographics
NPI:1861486045
Name:REXACH, VELDA YOLANDA (MD)
Entity Type:Individual
Prefix:MS
First Name:VELDA
Middle Name:YOLANDA
Last Name:REXACH
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 1:13000 BRUCE B DOWNS BLVD
Mailing Address - Street 2:MH & BS (116A)
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4745
Mailing Address - Country:US
Mailing Address - Phone:813-631-7135
Mailing Address - Fax:813-631-7128
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD
Practice Address - Street 2:MH & BS (116A)
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-631-7135
Practice Address - Fax:813-631-7128
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME990712084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200016340AMedicaid
OK100522058Medicare ID - Type Unspecified
OK200016340AMedicaid