Healthcare Provider Details

I. General information

NPI: 1720420557
Provider Name (Legal Business Name): SARA ELIZABETH ANCELLO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3638 E SOUTHERN AVE STE C101
MESA AZ
85206-2563
US

IV. Provider business mailing address

3638 E SOUTHERN AVE STE C101
MESA AZ
85206-2563
US

V. Phone/Fax

Practice location:
  • Phone: 480-564-3763
  • Fax: 480-716-3723
Mailing address:
  • Phone: 480-564-3763
  • Fax: 480-716-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number007159
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: