Basic Information
| Provider Information | |||||||||
| NPI: | 1841515277 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANKARA N DINAVAHI MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11321 CORTEZ BLVD | ||||||||
| Address2: | |||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346135407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525972009 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11321 CORTEZ BLVD | ||||||||
| Address2: | |||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346135407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525972009 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2010 | ||||||||
| LastUpdateDate: | 07/01/2010 | ||||||||
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| AuthorizedOfficialLastName: | DINAVAHI | ||||||||
| AuthorizedOfficialFirstName: | SANKARA | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3525972009 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.