Provider Demographics
NPI:1891734752
Name:DEVABHAKTUNI, VENKATA S (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:S
Last Name:DEVABHAKTUNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SIVLEY RD SW
Mailing Address - Street 2:STE 570
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5102
Mailing Address - Country:US
Mailing Address - Phone:256-265-6171
Mailing Address - Fax:256-265-6174
Practice Address - Street 1:201 SIVLEY RD SW
Practice Address - Street 2:STE 570
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5102
Practice Address - Country:US
Practice Address - Phone:256-265-6171
Practice Address - Fax:256-265-6174
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000173352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALFED BCBSOther051524047
ALBCBSOther51524072
ALE92485Medicare UPIN