Healthcare Provider Details

I. General information

NPI: 1780020123
Provider Name (Legal Business Name): SARANYA SASIDHARAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N FRESNO STREET DEPARTMENT OF GASTROENTEROLOGY
FRESNO CA
93701
US

IV. Provider business mailing address

155 N FRESNO STREET
FRESNO CA
93701
US

V. Phone/Fax

Practice location:
  • Phone: 559-499-6500
  • Fax: 617-667-8098
Mailing address:
  • Phone: 559-499-6500
  • Fax: 617-638-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number256204
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC173865
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: