Provider Demographics
NPI:1043480361
Name:BHASHYAM, SIVA K (MD)
Entity Type:Individual
Prefix:
First Name:SIVA
Middle Name:K
Last Name:BHASHYAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MAGNOLIA AVE SW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-2943
Mailing Address - Country:US
Mailing Address - Phone:863-269-0210
Mailing Address - Fax:863-824-7097
Practice Address - Street 1:201 MAGNOLIA AVE SW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-2943
Practice Address - Country:US
Practice Address - Phone:863-269-0210
Practice Address - Fax:863-824-7097
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428217207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease