Healthcare Provider Details

I. General information

NPI: 1396187225
Provider Name (Legal Business Name): SHRUTI SASTRY M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 PITT ST
SHARON PA
16146-2102
US

IV. Provider business mailing address

100 SHENANGO AVE
SHARON PA
16146-1503
US

V. Phone/Fax

Practice location:
  • Phone: 724-342-4052
  • Fax: 724-342-4053
Mailing address:
  • Phone: 724-342-4052
  • Fax: 724-342-4053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18371
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD458506
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: