Provider Demographics
NPI:1255015004
Name:GRENTON, SASHA LAKIS
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:LAKIS
Last Name:GRENTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:LAKIS
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:233 E MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-1507
Mailing Address - Country:US
Mailing Address - Phone:315-925-3244
Mailing Address - Fax:
Practice Address - Street 1:233 E MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-1507
Practice Address - Country:US
Practice Address - Phone:325-925-3244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY678086163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse