Provider Demographics
NPI:1851595367
Name:GUTHIKONDA, SASIDHAR (MD)
Entity type:Individual
Prefix:
First Name:SASIDHAR
Middle Name:
Last Name:GUTHIKONDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 PALMAS INN WAY APT 2101
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-6704
Mailing Address - Country:US
Mailing Address - Phone:787-603-3883
Mailing Address - Fax:
Practice Address - Street 1:355 CALLE FONT MARTELO STE 105
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3249
Practice Address - Country:US
Practice Address - Phone:787-603-3883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR023764207RC0000X, 207RI0011X
GA057471207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA214686737A-MMedicaid
GA202I068937Medicare PIN