Provider Demographics
NPI:1700886017
Name:CAVANAGH, SASHA STOKES (MD)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:STOKES
Last Name:CAVANAGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:CAVANAGH
Other - Last Name:KRAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3703 ENSIGN RD NE # 10-B
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5038
Mailing Address - Country:US
Mailing Address - Phone:360-455-5091
Mailing Address - Fax:360-438-5057
Practice Address - Street 1:3703 ENSIGN RD NE # 10-B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5038
Practice Address - Country:US
Practice Address - Phone:360-455-5091
Practice Address - Fax:360-438-3057
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044724207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8422883Medicaid
WA8422883Medicaid
WA8422883Medicaid