Healthcare Provider Details

I. General information

NPI: 1477022663
Provider Name (Legal Business Name): SASHA M. DAVIDSON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 E COMMERCIAL BLVD STE 202
FORT LAUDERDALE FL
33308-3807
US

IV. Provider business mailing address

401 E LAS OLAS BLVD STE 130-415
FORT LAUDERDALE FL
33301-2210
US

V. Phone/Fax

Practice location:
  • Phone: 954-900-6228
  • Fax: 580-279-1132
Mailing address:
  • Phone: 202-276-8068
  • Fax: 580-279-1132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SASHA M DAVIDSON
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 202-276-8068