Healthcare Provider Details

I. General information

NPI: 1083553739
Provider Name (Legal Business Name): SASHA HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 BUCHANAN AVE
BEVERLY NJ
08010-2109
US

IV. Provider business mailing address

205 BUCHANAN AVE
BEVERLY NJ
08010-2109
US

V. Phone/Fax

Practice location:
  • Phone: 640-696-2648
  • Fax:
Mailing address:
  • Phone: 640-696-2648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: