Provider Demographics
NPI:1548640550
Name:VAIDYANATHAN, INDU (SLP)
Entity type:Individual
Prefix:
First Name:INDU
Middle Name:
Last Name:VAIDYANATHAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4258 HIGHWAY 49 S UNIT 554
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-0137
Mailing Address - Country:US
Mailing Address - Phone:704-559-9409
Mailing Address - Fax:
Practice Address - Street 1:4350 MAIN ST STE 217
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7448
Practice Address - Country:US
Practice Address - Phone:704-559-9409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11180235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist