Healthcare Provider Details

I. General information

NPI: 1710263975
Provider Name (Legal Business Name): SARAH ANN D'ALESSANDRO P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH ANN KELLY

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 MASON AVE
DAYTONA BEACH FL
32117-4611
US

IV. Provider business mailing address

1075 MASON AVE
DAYTONA BEACH FL
32117-4611
US

V. Phone/Fax

Practice location:
  • Phone: 386-255-4596
  • Fax: 386-257-0558
Mailing address:
  • Phone: 386-255-4596
  • Fax: 386-257-0558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9106205
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9106205
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9106205
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: