Provider Demographics
NPI:1912327214
Name:LOPEZ, SASHA (TSHH,MSED)
Entity Type:Individual
Prefix:MS
First Name:SASHA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:TSHH,MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8259 249TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-2519
Mailing Address - Country:US
Mailing Address - Phone:917-577-8624
Mailing Address - Fax:
Practice Address - Street 1:8259 249TH ST
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-2519
Practice Address - Country:US
Practice Address - Phone:917-577-8624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY446503041OtherTSHH