Healthcare Provider Details

I. General information

NPI: 1508847070
Provider Name (Legal Business Name): DEVENDRA N AMIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 KENT PL
CLEARWATER FL
33764-7526
US

IV. Provider business mailing address

2410 NORTHSIDE DR
CLEARWATER FL
33761-2236
US

V. Phone/Fax

Practice location:
  • Phone: 727-286-2411
  • Fax: 727-781-3312
Mailing address:
  • Phone: 727-499-0356
  • Fax: 727-781-3312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME0057186
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME0057186
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: