Provider Demographics
NPI:1245933357
Name:VASUDHAR, ANANYA
Entity type:Individual
Prefix:
First Name:ANANYA
Middle Name:
Last Name:VASUDHAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#15 BYRASANDRA MAIN ROAD
Mailing Address - Street 2:JAYANAGAR 1ST BLOCK EAST
Mailing Address - City:BENGALURU
Mailing Address - State:KARNATAKA
Mailing Address - Zip Code:560011
Mailing Address - Country:IN
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:224-727-9829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-51762084N0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program