Provider Demographics
NPI:1740623784
Name:VELISETTY, RENUKA (MD)
Entity type:Individual
Prefix:MS
First Name:RENUKA
Middle Name:
Last Name:VELISETTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:RENU
Other - Middle Name:
Other - Last Name:VELISETTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:611 N WYMORE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2843
Mailing Address - Country:US
Mailing Address - Phone:407-205-8105
Mailing Address - Fax:760-267-9154
Practice Address - Street 1:611 N WYMORE RD STE 220
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2843
Practice Address - Country:US
Practice Address - Phone:407-205-8105
Practice Address - Fax:760-267-9154
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-451812084P0804X, 2084P0800X
FLME1654502084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry