Provider Demographics
NPI:1104300359
Name:AYYAGARI, VINEELA
Entity type:Individual
Prefix:
First Name:VINEELA
Middle Name:
Last Name:AYYAGARI
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 1:9017 FLETCHER FARM CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-5867
Mailing Address - Country:US
Mailing Address - Phone:703-398-7944
Mailing Address - Fax:
Practice Address - Street 1:9017 FLETCHER FARM CT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20112-5867
Practice Address - Country:US
Practice Address - Phone:703-398-7944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-23
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLL9860213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery