Provider Demographics
NPI:1700494267
Name:GEEDIGUNTA, VAISHALI
Entity type:Individual
Prefix:
First Name:VAISHALI
Middle Name:
Last Name:GEEDIGUNTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 N JACKSON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1633
Mailing Address - Country:US
Mailing Address - Phone:408-866-4000
Mailing Address - Fax:408-871-5215
Practice Address - Street 1:227 N JACKSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1633
Practice Address - Country:US
Practice Address - Phone:408-866-4000
Practice Address - Fax:408-871-5215
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA194206207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program