Healthcare Provider Details

I. General information

NPI: 1275951824
Provider Name (Legal Business Name): SRINIVASAN SATHYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 W BRANDON BLVD
BRANDON FL
33511-5002
US

IV. Provider business mailing address

2629 WINDGUARD CIR STE 102
WESLEY CHAPEL FL
33544-7355
US

V. Phone/Fax

Practice location:
  • Phone: 813-388-2948
  • Fax: 813-388-6827
Mailing address:
  • Phone: 813-388-2948
  • Fax: 813-388-6827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME135791
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME135791
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: