Provider Demographics
NPI:1184220543
Name:WILLIAMS, SASHA RENA
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:RENA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 BROAD AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4564
Mailing Address - Country:US
Mailing Address - Phone:330-685-5971
Mailing Address - Fax:
Practice Address - Street 1:346 BROAD AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4564
Practice Address - Country:US
Practice Address - Phone:330-685-5971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker