Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | ME136712 | FL |
NPI | 1407145709 |
---|---|
Provider Name | Mr. Amit Vinay Sastry |
First Address | Hialeah, FL 33016-5511 |
Second Address | Hialeah, FL 33016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2011 |
Last Update Date | 22/03/2019 |