Provider Demographics
NPI:1336830199
Name:SAKKOS, ANASTASIA ROSE (PA)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:ROSE
Last Name:SAKKOS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:ROSE
Other - Last Name:BRAVOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2650 RIDGE AVENUE
Mailing Address - Street 2:SUITE 1223
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 S MCHENRY RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6705
Practice Address - Country:US
Practice Address - Phone:847-618-0351
Practice Address - Fax:847-618-0766
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085009621363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant