Provider Demographics
NPI:1922403138
Name:NICOLLE, SASHA
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:NICOLLE
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 1:4036 MALAGA AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-6323
Mailing Address - Country:US
Mailing Address - Phone:305-495-5616
Mailing Address - Fax:
Practice Address - Street 1:401 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1151
Practice Address - Country:US
Practice Address - Phone:954-453-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health