MEDICARE: ANAGHA SADASIVAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		MD

General Provider Information

NPI Number	:	1538863733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANAGHA SADASIVAN

Provider Business Mailing Address
First Line	:	6201 GREENLEIGH AVE
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-2004
Country	:	US
Telephone Number	:	410-933-2704
Fax Number	:	410-500-4266

Provider Business Practice Location Address
First Line	:	1993 NW 74TH WAY
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-1066
Country	:	US
Telephone Number	:	954-288-9920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2023
Last Update Date	:	06/24/2026

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