Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | ME52275 | FL |
NPI | 1043203888 |
---|---|
Provider Name | Anju Vasudevan |
First Address | Ocala, FL 34474-4445 |
Second Address | Ocala, FL 34474-4445 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2005 |
Last Update Date | 16/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
061804700 | (05) | FL |
E30587 | (02) | FL |