Healthcare Provider Details

I. General information

NPI: 1891424024
Provider Name (Legal Business Name): SADIE KNIGHT WANNAMAKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 MONTVALE AVE STE 1400
STONEHAM MA
02180-3629
US

IV. Provider business mailing address

509 BILTMORE AVE
ASHEVILLE NC
28801-4601
US

V. Phone/Fax

Practice location:
  • Phone: 781-279-7040
  • Fax: 781-279-8430
Mailing address:
  • Phone: 828-213-1994
  • Fax: 828-213-1992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-12307
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: