Provider Demographics
NPI:1043672298
Name:DE JESUS, SASHA (MD)
Entity type:Individual
Prefix:DR
First Name:SASHA
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1364
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07096-1364
Mailing Address - Country:US
Mailing Address - Phone:551-229-5083
Mailing Address - Fax:212-402-1325
Practice Address - Street 1:187 BLUE HERON DR
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2938
Practice Address - Country:US
Practice Address - Phone:551-229-5083
Practice Address - Fax:212-402-1325
Is Sole Proprietor?:No
Enumeration Date:2016-03-27
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299551207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
253957109OtherDRIVER'S LICENSE