Healthcare Provider Details

I. General information

NPI: 1750561569
Provider Name (Legal Business Name): SHYAMSUNDER BRINDAVAN SABAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 03/19/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610
US

IV. Provider business mailing address

PO BOX 100374
GAINESVILLE FL
32610-0374
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0296
  • Fax: 352-265-0292
Mailing address:
  • Phone: 352-265-0296
  • Fax: 352-265-0292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD435810
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number52927
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME136770
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301500347
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number4301500347
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number52927
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD435810
License Number StatePA
# 8
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberME136770
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: