Healthcare Provider Details

I. General information

NPI: 1386750750
Provider Name (Legal Business Name): SATHYA NARAYAN RAU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SATHYANARAYAN RAU MD

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9406 BALM RIVERVIEW RD
RIVERVIEW FL
33569-5116
US

IV. Provider business mailing address

9406 BALM RIVERVIEW RD
RIVERVIEW FL
33569-5116
US

V. Phone/Fax

Practice location:
  • Phone: 813-349-7800
  • Fax: 813-349-7861
Mailing address:
  • Phone: 813-236-9310
  • Fax: 813-236-9311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME88367
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: