Healthcare Provider Details

I. General information

NPI: 1194916502
Provider Name (Legal Business Name): SARA SIBLEY SERIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA DIANN SIBLEY MD

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70508-6902
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-5634
  • Fax: 337-981-8303
Mailing address:
  • Phone: 337-470-5634
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.202031
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number237168
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number202031
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: