MEDICARE: DASIKA 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	208600000X	Surgery Physician	MD034337L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	120955	OTHER	PA	PA BLUE SHIELD

General Provider Information

NPI Number	:	1700887114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DASIKA SASTRY MD

Provider Business Mailing Address
First Line	:	1650 HUNTINGDON PIKE
Second Line	:	SUITE 311
City	:	MEADOWBROOK
State	:	PA
Zip	:	19046-8004
Country	:	US
Telephone Number	:	215-947-5345
Fax Number	:	215-947-6961

Provider Business Practice Location Address
First Line	:	1650 HUNTINGDON PIKE
Second Line	:	SUITE 311
City	:	MEADOWBROOK
State	:	PA
Zip	:	19046-8004
Country	:	US
Telephone Number	:	215-947-5345
Fax Number	:	215-947-6961

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	08/17/2007

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Directions to “ DASIKA SASTRY MD” Practice Location

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