Healthcare Provider Details

I. General information

NPI: 1518904077
Provider Name (Legal Business Name): SANJAY AWASTHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11621 KEW GARDENS AVE STE 101A
PALM BEACH GARDENS FL
33410-2853
US

IV. Provider business mailing address

PO BOX 160748
ALTAMONTE SPRINGS FL
32716-0748
US

V. Phone/Fax

Practice location:
  • Phone: 561-253-3980
  • Fax: 561-253-3985
Mailing address:
  • Phone: 561-253-3980
  • Fax: 561-253-3985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberC54833
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberH7117
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: