Provider Demographics
NPI:1700887114
Name:SASTRY, DASIKA (MD)
Entity Type:Individual
Prefix:
First Name:DASIKA
Middle Name:
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 1:1650 HUNTINGDON PIKE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8004
Mailing Address - Country:US
Mailing Address - Phone:215-947-5345
Mailing Address - Fax:215-947-6961
Practice Address - Street 1:1650 HUNTINGDON PIKE
Practice Address - Street 2:SUITE 311
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8004
Practice Address - Country:US
Practice Address - Phone:215-947-5345
Practice Address - Fax:215-947-6961
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034337L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA120955OtherPA BLUE SHIELD
PA120955Medicare PIN
B37182Medicare UPIN