Provider Demographics
NPI:1972599405
Name:VEMULA, VASUNDHARA-DEVI (MD)
Entity Type:Individual
Prefix:DR
First Name:VASUNDHARA-DEVI
Middle Name:
Last Name:VEMULA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VASU
Other - Middle Name:
Other - Last Name:VEMULA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:365 BUTTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1222
Mailing Address - Country:US
Mailing Address - Phone:415-994-9906
Mailing Address - Fax:415-295-7080
Practice Address - Street 1:810 5TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3252
Practice Address - Country:US
Practice Address - Phone:415-994-9906
Practice Address - Fax:415-295-7080
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1452232084P0800X, 2084P0804X, 2084P0804X
KY379842084P0802X, 2084P0804X, 2084P0805X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64067812Medicaid
KY37984OtherKENTUCKY LICENSE #
NY177740OtherNEW YORK LICENSE #
CAC145223OtherCALIFORNIA MEDICAL LICENSE
CAC145223OtherCALIFORNIA MEDICAL LICENSE
1939501Medicare PIN
NY177740OtherNEW YORK LICENSE #