Healthcare Provider Details

I. General information

NPI: 1902153299
Provider Name (Legal Business Name): SANDEEP KASHYAP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SANDEEP SACHIDANANDA MD

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MACCORKLE AVE SE STE 101
CHARLESTON WV
25304-1215
US

IV. Provider business mailing address

400 ASSOCIATION DR STE 102
CHARLESTON WV
25311-1298
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-5395
  • Fax: 304-388-5398
Mailing address:
  • Phone: 304-388-0151
  • Fax: 304-388-1721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number31603
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: