Healthcare Provider Details

I. General information

NPI: 1861311623
Provider Name (Legal Business Name): SASIDHAR MEDICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 N CENTRAL AVE STE A220
PHOENIX AZ
85012-2645
US

IV. Provider business mailing address

3101 N CENTRAL AVE STE A220
PHOENIX AZ
85012-2645
US

V. Phone/Fax

Practice location:
  • Phone: 469-891-4211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SASIDHAR REDDY NAGELLA
Title or Position: OWNER
Credential:
Phone: 469-891-4211