Healthcare Provider Details

I. General information

NPI: 1225670367
Provider Name (Legal Business Name): SARAH ROUSAKIS PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 S CREYTS RD STE A
LANSING MI
48917-8290
US

IV. Provider business mailing address

151 SOUTHHALL LN STE 300
MAITLAND FL
32751-7172
US

V. Phone/Fax

Practice location:
  • Phone: 517-886-0333
  • Fax: 517-886-2072
Mailing address:
  • Phone: 517-886-0333
  • Fax: 517-886-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10002819A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: