Provider Demographics
NPI:1790418796
Name:MCGOWAN, SASHA LESHAY
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:LESHAY
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2764 PLEASANT RD STE A
Mailing Address - Street 2:PMB 10238
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-7214
Mailing Address - Country:US
Mailing Address - Phone:704-804-8346
Mailing Address - Fax:
Practice Address - Street 1:14136 RIVERGATE PKWY STE 116
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-8889
Practice Address - Country:US
Practice Address - Phone:704-804-8346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty