Basic Information
| Provider Information | |||||||||
| NPI: | 1073596276 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YELLAYI | ||||||||
| FirstName: | PRIYA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | AKELLA | ||||||||
| OtherFirstName: | PRIYA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1075 STEPHENSON AVENUE | ||||||||
| Address2: | PATTERSON ARMY HEALTH CLINIC | ||||||||
| City: | FORT MONMOUTH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077035000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325320182 | ||||||||
| FaxNumber: | 7325320194 | ||||||||
| Practice Location | |||||||||
| Address1: | 1075 STEPHENSON AVENUE | ||||||||
| Address2: | PATTERSON ARMY HEALTH CLINIC | ||||||||
| City: | FORT MONMOUTH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077035000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325320182 | ||||||||
| FaxNumber: | 7325320194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | X | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MA065397 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.