Provider Demographics
NPI:1679967889
Name:BERGERON, SASHA TOVA (NP)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:TOVA
Last Name:BERGERON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:TOVA STURMAN
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4701 SANGAMORE ROAD
Mailing Address - Street 2:SUITE 100N #2042
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816
Mailing Address - Country:US
Mailing Address - Phone:301-363-2233
Mailing Address - Fax:240-696-0177
Practice Address - Street 1:4701 SANGAMORE ROAD
Practice Address - Street 2:SUITE 100N #2042
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20816
Practice Address - Country:US
Practice Address - Phone:301-363-2233
Practice Address - Fax:240-696-0177
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR241260363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health