Provider Demographics
NPI:1902606072
Name:SASSO, MICHELLE LISA
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LISA
Last Name:SASSO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 TACKLE AVE
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2265
Mailing Address - Country:US
Mailing Address - Phone:609-994-2865
Mailing Address - Fax:
Practice Address - Street 1:243 TACKLE AVE
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2265
Practice Address - Country:US
Practice Address - Phone:609-994-2865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0451237387343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)