Healthcare Provider Details

I. General information

NPI: 1043365406
Provider Name (Legal Business Name): GARY SAJKO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2463 PRUDEN BLVD
SUFFOLK VA
23434-4235
US

IV. Provider business mailing address

2016 MEADE PKWY
SUFFOLK VA
23434-4259
US

V. Phone/Fax

Practice location:
  • Phone: 757-925-1136
  • Fax: 757-925-0353
Mailing address:
  • Phone: 757-539-1533
  • Fax: 757-539-6591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0102036877
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: