Individual
MAYILATHAL VASUDEVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3140 PRINCETON PIKE FL 2, LAWRENCEVILLE, NJ 08648-2330
(609) 895-1919
(609) 895-2900
Mailing address
1 VACCARO RD, LAWRENCEVILLE, NJ 08648-1324
(609) 213-8902
Taxonomy
Speciality
Code
Description
License number
State
163WN0800X
Neuroscience Registered Nurse
26NRI4696700
NJ
363LF0000X
Family Nurse Practitioner
Primary
26NJ01240200
NJ
Other
Enumeration date
04/14/2020
Last updated
06/22/2022
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