Healthcare Provider Details

I. General information

NPI: 1053004184
Provider Name (Legal Business Name): SASHA L PEREZ ST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2370 BRUCE B DOWNS BLVD STE 300
WESLEY CHAPEL FL
33544-9215
US

IV. Provider business mailing address

314 W WINDHORST RD
BRANDON FL
33510-2433
US

V. Phone/Fax

Practice location:
  • Phone: 813-973-1033
  • Fax: 844-495-7168
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number16213
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: