Healthcare Provider Details

I. General information

NPI: 1396077996
Provider Name (Legal Business Name): WHITNEY SARAH WOYDZIAK PA-C, MMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 12/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR MC 5119
STANFORD CA
94305-2200
US

IV. Provider business mailing address

300 PASTEUR DR MC 5119
STANFORD CA
94305-2200
US

V. Phone/Fax

Practice location:
  • Phone: 650-725-5079
  • Fax: 650-618-2748
Mailing address:
  • Phone: 650-725-5079
  • Fax: 650-618-2748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: