Provider Demographics
NPI:1417672460
Name:BRUNO, SASHA (LAC)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:BRUNO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4253 APPIAN WAY W
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1460
Mailing Address - Country:US
Mailing Address - Phone:740-708-2290
Mailing Address - Fax:
Practice Address - Street 1:941 CHATHAM LN STE 323
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2430
Practice Address - Country:US
Practice Address - Phone:614-233-1609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000414171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist