Provider Demographics
NPI:1972691590
Name:VELLANKI, VIJAYA V (MD)
Entity type:Individual
Prefix:DR
First Name:VIJAYA
Middle Name:V
Last Name:VELLANKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WARD AVE
Mailing Address - Street 2:SUITE 840
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1600
Mailing Address - Country:US
Mailing Address - Phone:808-522-4521
Mailing Address - Fax:808-522-3526
Practice Address - Street 1:1100 WARD AVE
Practice Address - Street 2:SUITE 840
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1600
Practice Address - Country:US
Practice Address - Phone:808-522-4521
Practice Address - Fax:808-522-3526
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-123262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI564080 02Medicaid
HI56408001OtherALOHA CARE - KAHI MOHALA
HI00A0251643OtherHMSA - STRAUB
HI56408002OtherALOHA CARE - STRAUB
HI564080 01Medicaid
HI569562OtherUHA - KAHI MOHALA
HIMD12326OtherMDX HAWAII - KAHI MOHALA
HI0000251645OtherHMSA - KAHI MOHALA
HI5695444OtherUHA - STRAUB
HI990298651-96706-G006OtherTRICARE - KAHI MOHALA
HIMD12326-01OtherMDX HAWAII - STRAUB
HI56408001OtherALOHA CARE - KAHI MOHALA
HII27311Medicare UPIN
HI564080 02Medicaid