Provider Demographics
NPI:1083484380
Name:HERNANDEZ, SASHA GAIL (RN)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:GAIL
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:GAIL
Other - Last Name:HUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 GEORGIA PINE PL
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-4107
Mailing Address - Country:US
Mailing Address - Phone:516-300-2194
Mailing Address - Fax:
Practice Address - Street 1:5 GEORGIA PINE PL
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-4107
Practice Address - Country:US
Practice Address - Phone:516-300-2194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY763645163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse