Provider Demographics
NPI:1255004891
Name:VATANDOUST, SASHA LYNN
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:LYNN
Last Name:VATANDOUST
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 1:9950 US 19 SUITE 202
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668
Mailing Address - Country:US
Mailing Address - Phone:813-508-1186
Mailing Address - Fax:
Practice Address - Street 1:9950 US 19 SUITE 202
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:35668
Practice Address - Country:US
Practice Address - Phone:813-508-1198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker