Basic Information
| Provider Information | |||||||||
| NPI: | 1053636324 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SATAHOO | ||||||||
| FirstName: | SHEVONNE | ||||||||
| MiddleName: | SASHA LEE | ||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SATAHOO-DAWES | ||||||||
| OtherFirstName: | SHEVONNE | ||||||||
| OtherMiddleName: | SASHA LEE | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1850 NW 9TH ST STE T242 | ||||||||
| Address2: | DEPARTMENT OF SURGERY | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331253544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055851280 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1611 NW 12TH AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055851280 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2010 | ||||||||
| LastUpdateDate: | 08/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2086S0127X | ME141462 | FL | Y | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery |
No ID Information.