Basic Information
Provider Information
NPI: 1851792576
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MADDEN
FirstName: SASHA
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: ARNP, NP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 38135 MARKET SQUARE DR
Address2:  
City: ZEPHYRHILLS
State: FL
PostalCode: 335427505
CountryCode: US
TelephoneNumber: 3525670188
FaxNumber:  
Practice Location
Address1: 2352 BRUCE B DOWNS BLVD STE 301
Address2:  
City: WESLEY CHAPEL
State: FL
PostalCode: 335449203
CountryCode: US
TelephoneNumber: 8135284898
FaxNumber: 8133771004
Other Information
ProviderEnumerationDate: 09/12/2014
LastUpdateDate: 06/08/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/08/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XARNP9319649FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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