Provider Demographics
NPI:1336885524
Name:DASALLA, SACHA
Entity Type:Individual
Prefix:
First Name:SACHA
Middle Name:
Last Name:DASALLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:
Other - Last Name:DASALLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:912 W CHANDLER BLVD STE B-7
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2510
Mailing Address - Country:US
Mailing Address - Phone:480-637-4566
Mailing Address - Fax:
Practice Address - Street 1:912 W CHANDLER BLVD STE B-7
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2510
Practice Address - Country:US
Practice Address - Phone:480-637-4566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst