Provider Demographics
NPI:1760612758
Name:SASSO, ADAM R (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:R
Last Name:SASSO
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 1:2681 NE 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33334-2520
Mailing Address - Country:US
Mailing Address - Phone:631-327-1710
Mailing Address - Fax:703-271-0438
Practice Address - Street 1:2681 NE 8TH AVE
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33334-2520
Practice Address - Country:US
Practice Address - Phone:631-327-1710
Practice Address - Fax:703-271-0438
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0013233207Q00000X
GA83752207Q00000X
DCMD048606207Q00000X
ARE-13728207Q00000X
ALMD.41197207Q00000X
AK168126207Q00000X
AZ61473207Q00000X
CODR.0063260207Q00000X
PAMD468058207Q00000X
SCMMD.83213MD207Q00000X
VA0101248055207Q00000X
IL036.150514207Q00000X
CAC-165448207Q00000X
CT66918207Q00000X
FLME141543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101248055OtherLICENSE NUMBER