Healthcare Provider Details

I. General information

NPI: 1285590760
Provider Name (Legal Business Name): DONNETRA D SASARAKU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 W CORONA DR
CHANDLER AZ
85224-8557
US

IV. Provider business mailing address

1541 W CORONA DR UNIT 1148
CHANDLER AZ
85224-8557
US

V. Phone/Fax

Practice location:
  • Phone: 602-767-9752
  • Fax:
Mailing address:
  • Phone: 602-767-9752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License NumberAL12534H
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: