Provider Demographics
NPI:1477022663
Name:SASHA M. DAVIDSON, LLC
Entity Type:Organization
Organization Name:SASHA M. DAVIDSON, LLC
Other - Org Name:SIGNATURE PERINATAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-276-8068
Mailing Address - Street 1:401 E LAS OLAS BLVD STE 130-415
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2210
Mailing Address - Country:US
Mailing Address - Phone:202-276-8068
Mailing Address - Fax:580-279-1132
Practice Address - Street 1:2151 E COMMERCIAL BLVD STE 202
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3807
Practice Address - Country:US
Practice Address - Phone:954-900-6228
Practice Address - Fax:580-279-1132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-16
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017611500Medicaid