Provider Demographics
NPI:1902310212
Name:WILLIAMS KISTOO, SASHA ANN ANDREE
Entity type:Individual
Prefix:
First Name:SASHA ANN
Middle Name:ANDREE
Last Name:WILLIAMS KISTOO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 BAY 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4761
Mailing Address - Country:US
Mailing Address - Phone:718-253-1366
Mailing Address - Fax:
Practice Address - Street 1:195 BAY 19TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4761
Practice Address - Country:US
Practice Address - Phone:718-252-1366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-22
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator