Healthcare Provider Details

I. General information

NPI: 1093568594
Provider Name (Legal Business Name): SARAH MAE SMITH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E KATELLA AVE APT 3060
ANAHEIM CA
92805-6658
US

IV. Provider business mailing address

1801 E KATELLA AVE APT 3060
ANAHEIM CA
92805-6658
US

V. Phone/Fax

Practice location:
  • Phone: 518-496-5895
  • Fax:
Mailing address:
  • Phone: 518-496-5895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberPTL16677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: