Provider Demographics
NPI:1174767420
Name:BHASHYAM, SANDEEP RAO (MD)
Entity type:Individual
Prefix:MR
First Name:SANDEEP
Middle Name:RAO
Last Name:BHASHYAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL
Mailing Address - Street 2:MEDICAL STAFF OFFICE T14
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-7148
Mailing Address - Country:US
Mailing Address - Phone:631-444-2754
Mailing Address - Fax:631-444-6031
Practice Address - Street 1:101 NICOLLS ROAD
Practice Address - Street 2:HSC T16-020
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8160
Practice Address - Country:US
Practice Address - Phone:631-444-8478
Practice Address - Fax:631-444-7546
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2012-10-17
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Provider Licenses
StateLicense IDTaxonomies
NY2348651207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine