Provider Demographics
NPI:1285032532
Name:NELSON, SASHA (DVM)
Entity Type:Individual
Prefix:DR
First Name:SASHA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W 95TH ST
Mailing Address - Street 2:APT 2E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-8621
Mailing Address - Country:US
Mailing Address - Phone:201-213-3555
Mailing Address - Fax:
Practice Address - Street 1:565 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-2403
Practice Address - Country:US
Practice Address - Phone:646-201-9854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012284174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian
Provider Identifiers
StateIdentifier IDID TypeIssuer
FN3418933OtherDEA REGISTRATION NUMBER