Healthcare Provider Details

I. General information

NPI: 1548951296
Provider Name (Legal Business Name): SAGAR GADA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S PENINSULA DR
DAYTONA BEACH FL
32118-4422
US

IV. Provider business mailing address

222 S PENINSULA DR
DAYTONA BEACH FL
32118-4422
US

V. Phone/Fax

Practice location:
  • Phone: 386-310-2160
  • Fax: 386-310-2106
Mailing address:
  • Phone: 386-310-2160
  • Fax: 386-310-2106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME181318
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: