Provider Demographics
NPI:1679594899
Name:SAHOO, SANJIV KUMAR (MD)
Entity type:Individual
Prefix:
First Name:SANJIV
Middle Name:KUMAR
Last Name:SAHOO
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 1:2995 DREW ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-731-5269
Mailing Address - Fax:813-635-2613
Practice Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD STE 700
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6378
Practice Address - Country:US
Practice Address - Phone:813-321-1429
Practice Address - Fax:813-321-1431
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1011272084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0006081-01Medicaid
FL0006081-01Medicaid
FL0006081-01Medicaid
MN130001188Medicare PIN
FLAL010VMedicare PIN