Individual provider Active NPI

Sreedevi Venkatesh, AU.D

  • Audiologist
  • Peoria, IL
National Provider Identifier
1659382091
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
Practice address
411 Martin Luther King Jr Dr
Peoria, IL 61605-2414
Phone
(309) 497-0790
Fax
(309) 497-1343
NPI assigned
Aug 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X IL Primary

Addresses

Primary practice location

411 Martin Luther King Jr Dr
Peoria, IL 61605-2414

Mailing address

4122 Haley Drive
Peoria, IL 61615
Phone (309) 589-0119

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
147.000221ILMDAudiologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659382091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4122 HALEY DRIVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61615",
            "telephone_number": "309-589-0119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 MARTIN LUTHER KING JR DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616052414",
            "telephone_number": "309-497-0790",
            "fax_number": "309-497-1343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENKATESH",
        "first_name": "SREEDEVI",
        "name_prefix": "Dr.",
        "credential": "AU.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.