Provider Demographics
NPI:1982264933
Name:AGRAWAL, VEDANT (PHD)
Entity Type:Individual
Prefix:DR
First Name:VEDANT
Middle Name:
Last Name:AGRAWAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 EASY ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-3726
Mailing Address - Country:US
Mailing Address - Phone:650-739-9447
Mailing Address - Fax:
Practice Address - Street 1:400 ESTUDILLO AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4900
Practice Address - Country:US
Practice Address - Phone:650-336-0651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPSY34035103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program