Healthcare Provider Details

I. General information

NPI: 1629817739
Provider Name (Legal Business Name): SARAH CILLICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY BLVD STE 102
JUPITER FL
33458-2774
US

IV. Provider business mailing address

5680 ATLANTIC AVE APT 205
DELRAY BEACH FL
33484-8214
US

V. Phone/Fax

Practice location:
  • Phone: 561-622-6610
  • Fax:
Mailing address:
  • Phone: 630-470-4593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9118832
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: