Provider Demographics
NPI:1104908466
Name:VELLANKI, INDIRADEVI (MD)
Entity type:Individual
Prefix:DR
First Name:INDIRADEVI
Middle Name:
Last Name:VELLANKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:INDIRADEVI
Other - Middle Name:
Other - Last Name:MALEMPATI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8536 CROW DR
Mailing Address - Street 2:SUIT-200
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-1900
Mailing Address - Country:US
Mailing Address - Phone:330-777-9242
Mailing Address - Fax:
Practice Address - Street 1:8536 CROW DR
Practice Address - Street 2:SUIT-200
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-1900
Practice Address - Country:US
Practice Address - Phone:330-777-9242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH48600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine