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General NPI Number Information
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NPI Number | 1407048028
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Entity Type | Individual
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Provider Name | KOUSALYA SARA MD
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Gender | Female
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 06/03/2020
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Provider Practice Location Address
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Address Line | 2700 HEALING WAY STE 303
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City | WESLEY CHAPEL
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State | FL
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Zip | 33543-5471
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Country | US
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Telephone | 813-929-5380
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Fax | 813-929-5991
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Provider Business Mailing Address
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Address Line | 2700 HEALING WAY STE 303
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City | WESLEY CHAPEL
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State | FL
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Zip | 33543-5471
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Country | US
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Telephone | 813-929-5380
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Fax | 813-929-5991
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 60230
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME99943
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License Number State | FL
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