Provider Demographics
NPI:1235768151
Name:GRAY, SASHA (MSN, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MSN, CPNP-PC
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, CPNP-PC
Mailing Address - Street 1:9624 SANDY POINTE CIR APT 203
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7780
Mailing Address - Country:US
Mailing Address - Phone:631-252-4772
Mailing Address - Fax:
Practice Address - Street 1:20 DOC STONE RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-4515
Practice Address - Country:US
Practice Address - Phone:540-602-7766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178835363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty