Provider Demographics
NPI:1245798800
Name:GRANADILLO, SASHA (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:GRANADILLO
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 770133
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-0003
Mailing Address - Country:US
Mailing Address - Phone:786-290-6600
Mailing Address - Fax:
Practice Address - Street 1:7300 SW 62ND PL FL 4
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4800
Practice Address - Country:US
Practice Address - Phone:305-662-7901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-03
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001067207VE0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty