Basic Information
| Provider Information | |||||||||
| NPI: | 1104446426 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SASI | ||||||||
| FirstName: | SHARAT | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9032 ROLLING HILLS DR | ||||||||
| Address2: | |||||||||
| City: | ALEXANDER | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720022896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019086799 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9601 BAPTIST HEALTH DR | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722056321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012022093 | ||||||||
| FaxNumber: | 5012026316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2020 | ||||||||
| LastUpdateDate: | 07/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 126241 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.