Provider Demographics
NPI:1639583909
Name:BASHYAM, SARA
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:BASHYAM
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SARASWATHI
Other - Middle Name:A
Other - Last Name:BASHYAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:483 N SEMORAN BLVD
Mailing Address - Street 2:102
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3800
Mailing Address - Country:US
Mailing Address - Phone:407-645-1847
Mailing Address - Fax:321-274-0246
Practice Address - Street 1:483 N SEMORAN BLVD
Practice Address - Street 2:102
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3800
Practice Address - Country:US
Practice Address - Phone:407-645-1847
Practice Address - Fax:321-274-0246
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2112632363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health