Healthcare Provider Details

I. General information

NPI: 1477521524
Provider Name (Legal Business Name): SASHIDHAR V. GANTA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11851 JOLLYVILLE RD STE 104
AUSTIN TX
78759-2350
US

IV. Provider business mailing address

PO BOX 200185
AUSTIN TX
78720-0185
US

V. Phone/Fax

Practice location:
  • Phone: 512-257-2425
  • Fax: 512-257-2426
Mailing address:
  • Phone: 512-244-6452
  • Fax: 512-244-6582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberM2325
License Number StateTX

VIII. Authorized Official

Name: DR. SASHIDHAR V. GANTA
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 512-244-6452