Provider Demographics
NPI:1053086041
Name:PEREZ, SASHA DAFNE
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:DAFNE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 WALDEN CIR APT 1012
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-7238
Mailing Address - Country:US
Mailing Address - Phone:787-431-0095
Mailing Address - Fax:
Practice Address - Street 1:618 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5262
Practice Address - Country:US
Practice Address - Phone:407-343-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health