Provider Demographics
NPI:1700092939
Name:MAYA SASTRY
Entity Type:Organization
Organization Name:MAYA SASTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SASTRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-796-2579
Mailing Address - Street 1:39039 PASEO PADRE PKWY
Mailing Address - Street 2:204
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1620
Mailing Address - Country:US
Mailing Address - Phone:510-796-2579
Mailing Address - Fax:510-796-2589
Practice Address - Street 1:39001 SUNDALE DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2005
Practice Address - Country:US
Practice Address - Phone:510-796-1100
Practice Address - Fax:510-796-2589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA6973412084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA697341Medicaid
CAA697341Medicaid
CAA697341Medicare ID - Type Unspecified