Provider Demographics
NPI:1972805141
Name:RINGDAHL IVERSEN, SASHA MARIE (DO)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:MARIE
Last Name:RINGDAHL IVERSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13702 SANDFORD LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-2793
Mailing Address - Country:US
Mailing Address - Phone:281-912-3483
Mailing Address - Fax:
Practice Address - Street 1:9432 KATY FWY STE 400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6367
Practice Address - Country:US
Practice Address - Phone:281-912-3483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRESIDENT PHYSICIAN208100000X
TXP4106208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX375286Medicare PIN