Healthcare Provider Details

I. General information

NPI: 1558810317
Provider Name (Legal Business Name): ELITE ORTHOPEDICS AND SPORTS MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 05/16/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 SE 25TH LOOP UNIT 103
OCALA FL
34471-1072
US

IV. Provider business mailing address

3101 SW 34TH AVE #905-273
OCALA FL
34474-7447
US

V. Phone/Fax

Practice location:
  • Phone: 352-509-3097
  • Fax: 352-509-3129
Mailing address:
  • Phone: 352-509-3097
  • Fax: 352-509-3129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DEENESH T SAHAJPAL
Title or Position: OWNER
Credential: MD
Phone: 352-509-3097