Provider Demographics
NPI:1326777087
Name:SUSHENKO, SASHA DANIELA
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:DANIELA
Last Name:SUSHENKO
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 1:1325 AIRMOTIVE WAY STE 240
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3284
Mailing Address - Country:US
Mailing Address - Phone:775-737-9001
Mailing Address - Fax:775-870-1682
Practice Address - Street 1:1325 AIRMOTIVE WAY STE 240
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3284
Practice Address - Country:US
Practice Address - Phone:775-737-9001
Practice Address - Fax:775-870-1682
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist