Healthcare Provider Details

I. General information

NPI: 1598706350
Provider Name (Legal Business Name): CHINMAYI SASHI P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHINMAYI SASHI PHYSICIAN ASSISTANT

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MDG- HLVC 101BODIN CIRCLE
TRAVIS AFB CA
94535-1800
US

IV. Provider business mailing address

60 MDG- HLVC 101BODIN CIRCLE
TRAVIS AFB CA
94535-1800
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-2300
  • Fax:
Mailing address:
  • Phone: 707-423-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number53054
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA53054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: