Provider Demographics
NPI:1841883030
Name:BRAVO, SASHA (NP)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:BRAVO
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:921 E BROAD ST # 1065
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-1960
Mailing Address - Country:US
Mailing Address - Phone:919-769-1910
Mailing Address - Fax:919-214-5388
Practice Address - Street 1:174 MINE LAKE CT STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6417
Practice Address - Country:US
Practice Address - Phone:919-769-1910
Practice Address - Fax:919-214-5388
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2023-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC5014097363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health