Healthcare Provider Details

I. General information

NPI: 1598279838
Provider Name (Legal Business Name): SARAH MOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2017
Last Update Date: 11/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 KELLER AVE
OAKLAND CA
94605-4281
US

IV. Provider business mailing address

15 PACIFIC BAY CIR APT 102
SAN BRUNO CA
94066-6148
US

V. Phone/Fax

Practice location:
  • Phone: 201-693-3589
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: