Provider Demographics
NPI:1255372199
Name:SASTRY, ASHOK DATTU (MD)
Entity type:Individual
Prefix:DR
First Name:ASHOK
Middle Name:DATTU
Last Name:SASTRY
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 1:1921 WALDEMERE ST
Mailing Address - Street 2:SUITE 413
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2943
Mailing Address - Country:US
Mailing Address - Phone:941-917-6585
Mailing Address - Fax:941-917-6514
Practice Address - Street 1:1921 WALDEMERE ST
Practice Address - Street 2:SUITE 413
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2943
Practice Address - Country:US
Practice Address - Phone:941-917-6585
Practice Address - Fax:941-917-6514
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95950207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53338OtherBLUE CROSS BLUE SHEILD OF FLORIDA
FLME95950OtherFL MEDICAL LICENSE
FL275834200Medicaid
FL275834200Medicaid
FLI57168Medicare UPIN