1033391990 NPI number — ROHINI SASTRY M.D. PA

Table of content: (NPI 1033391990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033391990 NPI number — ROHINI SASTRY M.D. PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROHINI SASTRY M.D. PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033391990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1414 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEESBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34748-5329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-728-2110
Provider Business Mailing Address Fax Number:
352-728-2115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2785 S BAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUSTIS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32726-6591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-728-2110
Provider Business Practice Location Address Fax Number:
352-728-2115
Provider Enumeration Date:
12/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SASTRY
Authorized Official First Name:
ROHINI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
352-728-2110

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 17984Y . This is a "BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1568410900 . This is a "NPI #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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