Provider Demographics
NPI:1376571992
Name:SAKASH, SHELLIE (PT)
Entity Type:Individual
Prefix:
First Name:SHELLIE
Middle Name:
Last Name:SAKASH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 GREEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03813-5508
Mailing Address - Country:US
Mailing Address - Phone:603-662-3166
Mailing Address - Fax:
Practice Address - Street 1:2315 GREEN HILL RD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NH
Practice Address - Zip Code:03813-5508
Practice Address - Country:US
Practice Address - Phone:603-662-3166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3262225100000X
NH3366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432562499Medicaid