1073771309 NPI number — DR. ASHWANI SASTRY MD

Table of content: DR. ASHWANI SASTRY MD (NPI 1073771309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073771309 NPI number — DR. ASHWANI SASTRY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SASTRY
Provider First Name:
ASHWANI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1073771309
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2054 KILDAIRE FARM RD # 229
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27518-6614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-589-6968
Provider Business Mailing Address Fax Number:
919-869-2565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
821 S HORNER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27330-5359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-589-6968
Provider Business Practice Location Address Fax Number:
919-869-2565
Provider Enumeration Date:
05/22/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  2009-00668 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 0101268525 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 392993702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".