Healthcare Provider Details

I. General information

NPI: 1538813225
Provider Name (Legal Business Name): SACHA GOOCH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

8110 TIMBERLODGE TRL
DAYTON OH
45458-2102
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-3356
  • Fax:
Mailing address:
  • Phone: 937-545-3799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.007470
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: