Provider Demographics
NPI:1316925704
Name:RAJASEKHARA, SAHANA (MD)
Entity type:Individual
Prefix:DR
First Name:SAHANA
Middle Name:
Last Name:RAJASEKHARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SAHANA
Other - Middle Name:
Other - Last Name:GOWDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12902 USF MAGNOLIA DR
Mailing Address - Street 2:MRC-PSY
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-9416
Mailing Address - Country:US
Mailing Address - Phone:813-745-4673
Mailing Address - Fax:813-745-3906
Practice Address - Street 1:12902 USF MAGNOLIA DR
Practice Address - Street 2:MRC-PSY
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9416
Practice Address - Country:US
Practice Address - Phone:813-745-4673
Practice Address - Fax:813-745-3906
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98522207RH0002X, 207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02610180Medicaid
FL2781646 00Medicaid
NY02610180Medicaid
NYH96742Medicare UPIN