MEDICARE: SASHA JOSOVICH FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	355792	NY

General Provider Information

NPI Number	:	1104637081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SASHA JOSOVICH FNP

Provider Business Mailing Address
First Line	:	505 ORIENTAL BLVD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3733
Country	:	US
Telephone Number	:	646-761-6066
Fax Number	:

Provider Business Practice Location Address
First Line	:	1419 MERMAID AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-2615
Country	:	US
Telephone Number	:	718-210-3110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2025
Last Update Date	:	01/18/2025

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