Provider Demographics
NPI:1811183908
Name:VATSALA SASTRY MD PA
Entity type:Organization
Organization Name:VATSALA SASTRY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:VATSALA
Authorized Official - Middle Name:
Authorized Official - Last Name:SASTRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-279-2183
Mailing Address - Street 1:15435 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6113
Mailing Address - Country:US
Mailing Address - Phone:352-799-2294
Mailing Address - Fax:
Practice Address - Street 1:15435 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6113
Practice Address - Country:US
Practice Address - Phone:352-799-2294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377455402Medicaid
FLK2497Medicare PIN
FLG00799Medicare UPIN