MEDICARE: SASHIDHAR V. GANTA MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	M2325	TX

General Provider Information

NPI Number	:	1477521524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SASHIDHAR V. GANTA MD PA

Provider Business Mailing Address
First Line	:	PO BOX 200185
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78720-0185
Country	:	US
Telephone Number	:	512-244-6452
Fax Number	:	512-244-6582

Provider Business Practice Location Address
First Line	:	11851 JOLLYVILLE RD STE 104
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-2350
Country	:	US
Telephone Number	:	512-257-2425
Fax Number	:	512-257-2426

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. SASHIDHAR V. GANTA
Credential	:	M.D.
Telephone Number	:	512-244-6452

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	12/17/2025

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