Healthcare Provider Details

I. General information

NPI: 1811183908
Provider Name (Legal Business Name): VATSALA SASTRY MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15435 CORTEZ BLVD
BROOKSVILLE FL
34613-6113
US

IV. Provider business mailing address

15435 CORTEZ BLVD
BROOKSVILLE FL
34613-6113
US

V. Phone/Fax

Practice location:
  • Phone: 352-799-2294
  • Fax:
Mailing address:
  • Phone: 352-799-2294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: VATSALA SASTRY
Title or Position: OWNER/DOCTOR
Credential: M.D.
Phone: 352-279-2183