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General NPI Number Information
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NPI Number | 1558246074
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Entity Type | Organization
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Legal Business Name | VASISTA PLLC
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 1211 UNION AVE
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City | MEMPHIS
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State | TN
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Zip | 38104-6638
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Country | US
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Telephone | 901-516-7000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 38056
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City | GERMANTOWN
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State | TN
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Zip | 38183-0056
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Country | US
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Telephone | 814-410-5696
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | SATYANARAYANA RAJU PUSAPATI
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Credential | MD
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Telephone | 814-410-5696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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