Provider Demographics
NPI:1639313315
Name:VASUDEVAN, VANITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:VANITHA
Middle Name:
Last Name:VASUDEVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 W 20TH AVE
Mailing Address - Street 2:SUITE # 615
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5529
Mailing Address - Country:US
Mailing Address - Phone:305-820-6657
Mailing Address - Fax:305-562-6658
Practice Address - Street 1:7150 W 20TH AVE
Practice Address - Street 2:SUITE # 615
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5529
Practice Address - Country:US
Practice Address - Phone:305-820-6657
Practice Address - Fax:305-562-6658
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2014-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN 13061390200000X
FLME 119341208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program