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General NPI Number Information
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NPI Number | 1336131481
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Entity Type | Individual
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Provider Name | VATSALA S SASTRY MD
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Gender | Female
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 15435 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-6113
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Country | US
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Telephone | 352-799-2294
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Fax | 352-796-8196
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Provider Business Mailing Address
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Address Line | 15435 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-6113
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Country | US
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Telephone | 352-799-2294
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Fax | 352-796-8196
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | ME68115
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License Number State | FL
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