Provider Demographics
NPI:1619074515
Name:ROHINI SASTRY MD PA
Entity Type:Organization
Organization Name:ROHINI SASTRY MD PA
Other - Org Name:ROHINI SASTRY M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROHINI
Authorized Official - Middle Name:
Authorized Official - Last Name:SASTRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-728-2110
Mailing Address - Street 1:1414 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5329
Mailing Address - Country:US
Mailing Address - Phone:352-728-2110
Mailing Address - Fax:352-728-2115
Practice Address - Street 1:801 E DIXIE AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7699
Practice Address - Country:US
Practice Address - Phone:352-728-2110
Practice Address - Fax:352-728-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62040207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4828Medicare ID - Type Unspecified
FLF38673Medicare UPIN