Healthcare Provider Details

I. General information

NPI: 1932944691
Provider Name (Legal Business Name): SARAH MOODY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH WHITE

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N GILBERT RD STE 206
GILBERT AZ
85234-2394
US

IV. Provider business mailing address

4254 E HARWELL CT
GILBERT AZ
85234-0121
US

V. Phone/Fax

Practice location:
  • Phone: 801-821-2613
  • Fax:
Mailing address:
  • Phone: 407-748-5722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number305932
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: