Healthcare Provider Details

I. General information

NPI: 1245885888
Provider Name (Legal Business Name): SARAH KATHLEEN HANEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 MEADOWS BLVD STE 200
CASTLE ROCK CO
80109-8405
US

IV. Provider business mailing address

2360 MEADOWS BLVD STE 200
CASTLE ROCK CO
80109-8405
US

V. Phone/Fax

Practice location:
  • Phone: 720-455-3775
  • Fax: 720-455-3776
Mailing address:
  • Phone: 720-455-3775
  • Fax: 720-455-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.5778
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: