Provider Demographics
NPI:1578637179
Name:SZYTEL, SASHA L (MD)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:L
Last Name:SZYTEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:L
Other - Last Name:VON STEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3241 S HIGUERA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6924
Mailing Address - Country:US
Mailing Address - Phone:805-544-4460
Mailing Address - Fax:
Practice Address - Street 1:3241 S HIGUERA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6924
Practice Address - Country:US
Practice Address - Phone:805-544-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89275208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A892750Medicare ID - Type Unspecified