Provider Demographics
NPI:1568418218
Name:COLEMAN, SASHA (PA)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PA
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 25328
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29224-5328
Mailing Address - Country:US
Mailing Address - Phone:843-788-5916
Mailing Address - Fax:
Practice Address - Street 1:311 CLUB COLONY CIRCLE
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-8282
Practice Address - Country:US
Practice Address - Phone:843-788-5916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCA587363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCA587OtherSC LICENSE #
SCA587OtherSC LICENSE #