Provider Demographics
NPI:1073180444
Name:KASHAT, SASHA SHAMMAMI (OD)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:SHAMMAMI
Last Name:KASHAT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:
Other - Last Name:SHAMMAMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1617 W HOUSTONIA AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3993
Mailing Address - Country:US
Mailing Address - Phone:248-497-8636
Mailing Address - Fax:
Practice Address - Street 1:1301 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7017
Practice Address - Country:US
Practice Address - Phone:248-643-9880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005510152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist