Provider Demographics
NPI:1164410650
Name:SASSANO, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:SASSANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3920 BEE RIDGE RD
Mailing Address - Street 2:STE F
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1207
Mailing Address - Country:US
Mailing Address - Phone:321-723-7716
Mailing Address - Fax:321-723-0604
Practice Address - Street 1:2222 S HARBOR CITY BLVD
Practice Address - Street 2:SUITE 610
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5594
Practice Address - Country:US
Practice Address - Phone:321-723-7716
Practice Address - Fax:321-723-0604
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME80970207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35824OtherBLUE CROSS BLUE SHIELD
FL35824YOtherMEDICARE - P10
FL271660OtherAVMED
FL271401900Medicaid
FL271660OtherAVMED