Healthcare Provider Details

I. General information

NPI: 1255004891
Provider Name (Legal Business Name): SASHA LYNN VATANDOUST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 07/29/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9950 US 19 SUITE 202
PORT RICHEY FL
35668
US

IV. Provider business mailing address

9950 US 19 SUITE 202
PORT RICHEY FL
34668
US

V. Phone/Fax

Practice location:
  • Phone: 813-508-1198
  • Fax:
Mailing address:
  • Phone: 813-508-1186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: