Provider Demographics
NPI:1982707196
Name:SASTRY, SRIDHARA (MD)
Entity Type:Individual
Prefix:
First Name:SRIDHARA
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:PO BOX 21727
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-1727
Mailing Address - Country:US
Mailing Address - Phone:727-823-2188
Mailing Address - Fax:727-828-0723
Practice Address - Street 1:5003 E LONGBOAT BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4229
Practice Address - Country:US
Practice Address - Phone:813-855-7884
Practice Address - Fax:813-854-4132
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME462632080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045861900Medicaid
FL03864OtherBCBS OF FL
FL03864OtherBCBS OF FL
D50856Medicare UPIN