Provider Demographics
NPI:1891779062
Name:SAHETA, SANJAYA N (MD)
Entity Type:Individual
Prefix:MR
First Name:SANJAYA
Middle Name:N
Last Name:SAHETA
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 1:11155 DUNN RD
Mailing Address - Street 2:SUITE 304E
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6150
Mailing Address - Country:US
Mailing Address - Phone:314-741-0911
Mailing Address - Fax:314-653-3671
Practice Address - Street 1:11155 DUNN RD
Practice Address - Street 2:SUITE 304E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6150
Practice Address - Country:US
Practice Address - Phone:314-741-0911
Practice Address - Fax:314-653-3671
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036130872207RC0000X, 207RI0011X
MO2012026130207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36130872Medicaid