Provider Demographics
NPI:1194922302
Name:SASANKAN, MAYADEVI (MD)
Entity type:Individual
Prefix:
First Name:MAYADEVI
Middle Name:
Last Name:SASANKAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 ROUTE 6 AND 209
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-7615
Mailing Address - Country:US
Mailing Address - Phone:570-296-5950
Mailing Address - Fax:570-296-1066
Practice Address - Street 1:510 ROUTE 6 AND 209
Practice Address - Street 2:SUITE 8
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-7615
Practice Address - Country:US
Practice Address - Phone:570-296-5950
Practice Address - Fax:570-296-1066
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228755208000000X
PAMD435628208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02496784Medicaid
PA102215516 0001Medicaid
PA136889YNKMedicare PIN
I26684Medicare UPIN
NY02496784Medicaid