Healthcare Provider Details

I. General information

NPI: 1457397069
Provider Name (Legal Business Name): SASH SESHADRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 TAMIAMI TRL
PORT CHARLOTTE FL
33952-5172
US

IV. Provider business mailing address

2841 TAMIAMI TRL
PORT CHARLOTTE FL
33952-5172
US

V. Phone/Fax

Practice location:
  • Phone: 941-627-5151
  • Fax: 941-629-2036
Mailing address:
  • Phone: 941-627-5151
  • Fax: 941-629-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME39902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: