Provider Demographics
NPI:1902607807
Name:JACKSON, SASHA C'MONE
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:C'MONE
Last Name:JACKSON
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 1:6073 GLENWAY DR APT N
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-1459
Mailing Address - Country:US
Mailing Address - Phone:216-543-0429
Mailing Address - Fax:
Practice Address - Street 1:6073 GLENWAY DR APT N
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-1459
Practice Address - Country:US
Practice Address - Phone:216-543-0429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist