MEDICARE: DR. ROHINI SASTRY MD

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME 62040	FL
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME62040	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17984	OTHER	FL	BLUE SHIELD PROV #

General Provider Information

NPI Number	:	1568410900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROHINI SASTRY MD

Provider Business Mailing Address
First Line	:	1414 EAST MAIN STREET
Second Line	:	SUITE 3
City	:	LEESBURG
State	:	FL
Zip	:	34748
Country	:	US
Telephone Number	:	352-728-2110
Fax Number	:	352-728-2115

Provider Business Practice Location Address
First Line	:	1414 EAST MAIN STREET
Second Line	:	SUITE 3
City	:	LEESBURG
State	:	FL
Zip	:	34748
Country	:	US
Telephone Number	:	352-728-2110
Fax Number	:	352-728-2115

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	12/01/2009

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