Provider Demographics
NPI:1376096537
Name:CLEMENDORE, SASHA ELYSE
Entity Type:Individual
Prefix:MS
First Name:SASHA
Middle Name:ELYSE
Last Name:CLEMENDORE
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 1:9919 AVENUE K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4421
Mailing Address - Country:US
Mailing Address - Phone:347-764-3087
Mailing Address - Fax:
Practice Address - Street 1:9919 AVENUE K
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4421
Practice Address - Country:US
Practice Address - Phone:347-764-3087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst