Healthcare Provider Details

I. General information

NPI: 1760460679
Provider Name (Legal Business Name): SABARETNAM YOGENDRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N BAY ST STE 4
EUSTIS FL
32726
US

IV. Provider business mailing address

720 N BAY ST STE 4
EUSTIS FL
32726-2964
US

V. Phone/Fax

Practice location:
  • Phone: 352-483-1960
  • Fax: 352-483-0660
Mailing address:
  • Phone: 352-483-1960
  • Fax: 352-483-0660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME55648
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME55648
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: