Provider Demographics
NPI:1477603611
Name:ROSE, SASHA L (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:SASHA
Middle Name:L
Last Name:ROSE
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 INDIA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4210
Mailing Address - Country:US
Mailing Address - Phone:207-347-7132
Mailing Address - Fax:207-347-3527
Practice Address - Street 1:83 INDIA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4210
Practice Address - Country:US
Practice Address - Phone:207-347-7132
Practice Address - Fax:207-347-3527
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2014-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC308171100000X
MENP #278175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist