Provider Demographics
NPI:1073771309
Name:SASTRY, ASHWANI (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHWANI
Middle Name:
Last Name:SASTRY
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 1:2054 KILDAIRE FARM RD # 229
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6614
Mailing Address - Country:US
Mailing Address - Phone:919-589-6968
Mailing Address - Fax:919-869-2565
Practice Address - Street 1:821 S HORNER BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5359
Practice Address - Country:US
Practice Address - Phone:919-589-6968
Practice Address - Fax:919-869-2565
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-00668207RI0011X
VA0101268525207RC0000X, 207RC0000X
NY249912207RI0011X
TXQ65682085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX392993702Medicaid