Provider Demographics
NPI:1326013822
Name:ASTHANA, SUSHIL KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:SUSHIL
Middle Name:KUMAR
Last Name:ASTHANA
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 1:1005 COLLEGE BLVD W
Mailing Address - Street 2:SUITE C
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1053
Mailing Address - Country:US
Mailing Address - Phone:850-678-3994
Mailing Address - Fax:
Practice Address - Street 1:1005 COLLEGE BLVD W
Practice Address - Street 2:SUITE C
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1053
Practice Address - Country:US
Practice Address - Phone:850-678-3994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30965208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD50946Medicare UPIN
FL4178Medicare ID - Type Unspecified