Provider Demographics
NPI:1356612931
Name:MEDINA, SASHA (MED)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 CLAY FIELD TRL
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-9296
Mailing Address - Country:US
Mailing Address - Phone:413-433-7392
Mailing Address - Fax:
Practice Address - Street 1:790 CLAY FIELD TRL
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-9296
Practice Address - Country:US
Practice Address - Phone:413-433-7392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303295OtherMBHP
MA8443OtherBMC
MA997303OtherNETWORK HEALTH