MEDICARE: MRS. SARAH JAYCE SMALLEY PA-C

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	363A00000X	Physician Assistant	085.002862	IL

General Provider Information

NPI Number	:	1316275662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH JAYCE SMALLEY PA-C

Provider Business Mailing Address
First Line	:	1900 SILVER CROSS BLVD
Second Line	:
City	:	NEW LENOX
State	:	IL
Zip	:	60451-9509
Country	:	US
Telephone Number	:	815-300-7106
Fax Number	:	815-300-7047

Provider Business Practice Location Address
First Line	:	540 W NORTH ST STE 207
Second Line	:
City	:	MANHATTAN
State	:	IL
Zip	:	60442-8202
Country	:	US
Telephone Number	:	815-478-7866
Fax Number	:	815-478-7674

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

Provider Enumeration Date	:	11/25/2009
Last Update Date	:	07/28/2022

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