MEDICARE: DR. SARA NICOLE SAYRE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	P.07773	OH

General Provider Information

NPI Number	:	1174005706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA NICOLE SAYRE PH.D.

Provider Business Mailing Address
First Line	:	4319 HILLS AND DALES RD NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-1663
Country	:	US
Telephone Number	:	330-492-2006
Fax Number	:	330-492-2161

Provider Business Practice Location Address
First Line	:	4319 HILLS AND DALES RD NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-1663
Country	:	US
Telephone Number	:	330-492-2006
Fax Number	:	330-492-2161

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2018
Last Update Date	:	03/19/2019

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