Individual
VISHNU P YELAMANCHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1050 OLD CAMP RD, STE 270, THE VILLAGES, FL 32162-1762
(352) 633-1966
(352) 633-1969
Mailing address
PO BOX 2198, LADY LAKE, FL 32158-2198
(352) 633-1966
(352) 633-1969
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
ME81426
FL
207RI0011X
Interventional Cardiology Physician
Primary
ME81426
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10724279
CAQH
FL
05
—
260284900
—
FL
01
—
3820541
CIGNA
FL
01
—
51757
BCBS
FL
01
—
ME81426
STATE LICENSE NUMBER
FL
01
—
P00119597
MEDICARE RR
FL
Enumeration date
11/29/2005
Last updated
07/29/2012
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