Provider Demographics
NPI:1497838205
Name:SASSANO, DAVID J (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:SASSANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14690 SPRING HILL DR STE 305
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-277-5348
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:401 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-3838
Practice Address - Country:US
Practice Address - Phone:352-419-6526
Practice Address - Fax:352-419-8966
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0S5374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010834800Medicaid
FL28607OtherBCBS FL
OH0501951Medicaid
FLP01338281OtherRAILROAD MEDICARE
FLP00447215OtherRR MEDICARE
OHSA0520457Medicare ID - Type Unspecified
FLAC740WMedicare PIN
FLAC740UMedicare PIN
FL28607OtherBCBS FL
FLAC740ZMedicare PIN