Healthcare Provider Details

I. General information

NPI: 1992524672
Provider Name (Legal Business Name): SANSA MED SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W HOLLIS ST STE 211
NASHUA NH
03062-1388
US

IV. Provider business mailing address

505 W HOLLIS ST STE 211
NASHUA NH
03062-1388
US

V. Phone/Fax

Practice location:
  • Phone: 978-245-5885
  • Fax:
Mailing address:
  • Phone: 978-245-5885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANJAY GUPTA
Title or Position: CEO
Credential: MD
Phone: 207-576-3296