Provider Demographics
NPI:1841515277
Name:SANKARA N DINAVAHI MD PA
Entity type:Organization
Organization Name:SANKARA N DINAVAHI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANKARA
Authorized Official - Middle Name:N
Authorized Official - Last Name:DINAVAHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-597-2009
Mailing Address - Street 1:11321 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5407
Mailing Address - Country:US
Mailing Address - Phone:352-597-2009
Mailing Address - Fax:
Practice Address - Street 1:11321 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5407
Practice Address - Country:US
Practice Address - Phone:352-597-2009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD21422Medicare UPIN