Provider Demographics
NPI:1861719494
Name:HABERLE, SASHA JENKINS (MD, MPH)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:JENKINS
Last Name:HABERLE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:NICOLE
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:10502 PARK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8479
Mailing Address - Country:US
Mailing Address - Phone:980-299-3926
Mailing Address - Fax:980-299-6736
Practice Address - Street 1:10502 PARK RD
Practice Address - Street 2:STE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8479
Practice Address - Country:US
Practice Address - Phone:980-299-3926
Practice Address - Fax:980-299-6736
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35. 123300207ND0101X
GA69679207ND0101X
NC2016-00779207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01486806OtherRAILROAD MEDICARE
OH000000877564OtherANTHEM BLUE CROSS/BLUE SHIELD
OH000000877564OtherANTHEM BLUE CROSS/BLUE SHIELD