Healthcare Provider Details

I. General information

NPI: 1932728383
Provider Name (Legal Business Name): PRIYA SASANKAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MICHIGAN AVE
MELBOURNE FL
32901-3100
US

IV. Provider business mailing address

PO BOX 361095
MELBOURNE FL
32936-1095
US

V. Phone/Fax

Practice location:
  • Phone: 321-952-0700
  • Fax: 321-952-4444
Mailing address:
  • Phone: 321-253-2900
  • Fax: 321-435-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME181454
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: