MEDICARE: SANJAY SURY SASTRY M. D.

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	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	ME84820	FL
2	208VP0000X	Pain Medicine Physician	ME 84820	FL

General Provider Information

NPI Number	:	1568531424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANJAY SURY SASTRY M. D.

Provider Business Mailing Address
First Line	:	801 BEVILLE RD
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-1860
Country	:	US
Telephone Number	:	407-473-5525
Fax Number	:	386-756-1697

Provider Business Practice Location Address
First Line	:	801 BEVILLE RD
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-1860
Country	:	US
Telephone Number	:	386-788-2300
Fax Number	:	386-756-1697

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	01/29/2024

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