Provider Demographics
NPI:1841485406
Name:NASTASI, BRYON EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:BRYON
Middle Name:EDWARD
Last Name:NASTASI
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 1:438 OLIVER RD
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1034
Mailing Address - Country:US
Mailing Address - Phone:708-359-4634
Mailing Address - Fax:
Practice Address - Street 1:800 PRUDENTIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8202
Practice Address - Country:US
Practice Address - Phone:614-210-1885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4449892085R0202X
VA01012821432085R0202X, 2085N0700X
FLME1651862085R0202X
NY3205352085R0202X
NC3184772085R0202X
OH35.1242152085R0202X
PAMT1913882085R0202X
SC895512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003808Medicaid
PA1027147120001Medicaid
PA2676190OtherBLUE CROSS BLUE SHIELD
PA240772FUDMedicare PIN