Provider Demographics
NPI:1457321903
Name:BHAVAN, SATHY VISAKAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SATHY
Middle Name:VISAKAN
Last Name:BHAVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:502 E NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5427
Mailing Address - Country:US
Mailing Address - Phone:321-727-2020
Mailing Address - Fax:321-984-9547
Practice Address - Street 1:2619 E COLORADO BLVD STE 150
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3747
Practice Address - Country:US
Practice Address - Phone:626-793-4168
Practice Address - Fax:626-463-1277
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME124912207W00000X
MO2004016660207W00000X
CAA98352207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209368406Medicaid
CA1457321903Medicaid
MOH92391Medicare UPIN