Provider Demographics
NPI:1417916701
Name:PRAKASH, SASHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SASHA
Middle Name:
Last Name:PRAKASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 AVENUE E
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3915
Mailing Address - Country:US
Mailing Address - Phone:201-858-8444
Mailing Address - Fax:201-858-4260
Practice Address - Street 1:534 AVENUE E
Practice Address - Street 2:SUITE 1-A
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3915
Practice Address - Country:US
Practice Address - Phone:201-858-8444
Practice Address - Fax:201-858-4260
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ34605207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE01287Medicare UPIN
NJ010731Medicare ID - Type Unspecified