Provider Demographics
NPI:1598345043
Name:UPADHYAYA, VEDANTI YOGESH (DO)
Entity type:Individual
Prefix:DR
First Name:VEDANTI
Middle Name:YOGESH
Last Name:UPADHYAYA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12702 N IH 35
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-2609
Mailing Address - Country:US
Mailing Address - Phone:210-650-9660
Mailing Address - Fax:210-654-1432
Practice Address - Street 1:12702 N IH 35
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-2609
Practice Address - Country:US
Practice Address - Phone:210-650-9660
Practice Address - Fax:210-654-1432
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV2308207Q00000X
MST-4438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine