Healthcare Provider Details

I. General information

NPI: 1538828918
Provider Name (Legal Business Name): INDI VASUDEVA NEPHROLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4218 W LINEBAUGH AVE
TAMPA FL
33624-5241
US

IV. Provider business mailing address

2410 NORTHSIDE DR
CLEARWATER FL
33761-2236
US

V. Phone/Fax

Practice location:
  • Phone: 813-269-7555
  • Fax: 813-269-7575
Mailing address:
  • Phone: 727-499-0351
  • Fax: 727-223-4159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. INDI VASUDEVA
Title or Position: OWNER
Credential: MD
Phone: 813-777-9605