Healthcare Provider Details

I. General information

NPI: 1447013172
Provider Name (Legal Business Name): SARAH DONNELLY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3466 PINE RIDGE RD
NAPLES FL
34109-3883
US

IV. Provider business mailing address

1741 BOXWOOD LN
NAPLES FL
34105-2243
US

V. Phone/Fax

Practice location:
  • Phone: 239-261-2663
  • Fax: 239-262-5633
Mailing address:
  • Phone: 727-560-7166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: