Provider Demographics
NPI:1285072868
Name:ANASTAS, SASCHA M (PA)
Entity type:Individual
Prefix:
First Name:SASCHA
Middle Name:M
Last Name:ANASTAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 1/2 DON GASPAR AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-0626
Mailing Address - Country:US
Mailing Address - Phone:970-618-4339
Mailing Address - Fax:
Practice Address - Street 1:1640 OLD PECOS TRL
Practice Address - Street 2:SUITE H
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4776
Practice Address - Country:US
Practice Address - Phone:505-992-0233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2013-0030363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant