Healthcare Provider Details

I. General information

NPI: 1194428458
Provider Name (Legal Business Name): SARAH JING-YA WU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE N
WORCESTER MA
01655-0002
US

IV. Provider business mailing address

55 LAKE AVE N
WORCESTER MA
01655-0002
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMT236728
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: