Provider Demographics
NPI:1437519592
Name:MATTHEWS, SIEDAH SASHA
Entity Type:Individual
Prefix:
First Name:SIEDAH
Middle Name:SASHA
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SIEDAH
Other - Middle Name:SASHA
Other - Last Name:CRICHTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5252 S TAMIAMI TRL STE 16
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-4233
Mailing Address - Country:US
Mailing Address - Phone:801-440-5592
Mailing Address - Fax:
Practice Address - Street 1:5252 S TAMIAMI TRL STE 16
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-4233
Practice Address - Country:US
Practice Address - Phone:801-440-5592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117429225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist