Provider Demographics
NPI:1417377839
Name:ALVARADO, SASHA AHANGAMA (DO)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:AHANGAMA
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:
Other - Last Name:AHANGAMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:623 W FM 544 STE 104
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4587
Mailing Address - Country:US
Mailing Address - Phone:972-521-3366
Mailing Address - Fax:972-422-5656
Practice Address - Street 1:623 W FM 544 STE 104
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4587
Practice Address - Country:US
Practice Address - Phone:972-521-3366
Practice Address - Fax:972-422-5656
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS0255207KA0200X
OK5706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS0255OtherSTATE LICENSE