Provider Demographics
NPI:1699538744
Name:MEDINA, SASHA (RBT)
Entity type:Individual
Prefix:MS
First Name:SASHA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9425 NW 114TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4204
Mailing Address - Country:US
Mailing Address - Phone:786-281-6543
Mailing Address - Fax:
Practice Address - Street 1:9425 NW 114TH LN
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4204
Practice Address - Country:US
Practice Address - Phone:786-281-6543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-319814106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician