Healthcare Provider Details

I. General information

NPI: 1053327692
Provider Name (Legal Business Name): SARAH ANDERSON O'NEILL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 STONEMARKER RD
MOORESVILLE NC
28117-6668
US

IV. Provider business mailing address

188 STONEMARKER RD
MOORESVILLE NC
28117-6668
US

V. Phone/Fax

Practice location:
  • Phone: 704-749-5800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-00106
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: