Provider Demographics
NPI:1457655284
Name:DUNBAR, SASHA CELESTE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:CELESTE
Last Name:DUNBAR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:919-496-5774
Mailing Address - Fax:919-496-2311
Practice Address - Street 1:205 SANDALWOOD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2679
Practice Address - Country:US
Practice Address - Phone:919-496-5774
Practice Address - Fax:919-496-2311
Is Sole Proprietor?:No
Enumeration Date:2011-01-09
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC193183363LF0000X
NC5005047363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005554Medicaid
NC2595280Medicare PIN