Healthcare Provider Details

I. General information

NPI: 1891981304
Provider Name (Legal Business Name): SHEETHU SADASIVAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 N RONALD REAGAN PKWY STE 206
AVON IN
46123-6911
US

IV. Provider business mailing address

250 N SHADELAND AVE STE 130 - PROVIDER ENROLLMENT
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-217-2888
  • Fax: 317-217-2999
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD170350
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01071884A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: