Provider Demographics
NPI:1336594563
Name:VELLANKI, NAREN T (MD)
Entity type:Individual
Prefix:
First Name:NAREN
Middle Name:T
Last Name:VELLANKI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-2771
Mailing Address - Country:US
Mailing Address - Phone:812-231-8242
Mailing Address - Fax:812-954-0127
Practice Address - Street 1:620 8TH AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-2771
Practice Address - Country:US
Practice Address - Phone:812-231-8323
Practice Address - Fax:812-954-0141
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1482412084P0800X
390200000X
IN01083568A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300030605Medicaid
FL110305600Medicaid
KY7100528880Medicaid