Provider Demographics
NPI:1740720432
Name:JILLAPALLI, DEVANAND (MD)
Entity type:Individual
Prefix:
First Name:DEVANAND
Middle Name:
Last Name:JILLAPALLI
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 1:10 CENTER DR
Mailing Address - Street 2:BUILDING 10 CRC ROOM 7-5680
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-1404
Mailing Address - Country:US
Mailing Address - Phone:301-496-7428
Mailing Address - Fax:
Practice Address - Street 1:10 CENTER DR
Practice Address - Street 2:BUILDING 10 CRC ROOM 7-5680
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-1404
Practice Address - Country:US
Practice Address - Phone:301-496-7428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210589-1204R00000X, 2084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology