Healthcare Provider Details

I. General information

NPI: 1093958191
Provider Name (Legal Business Name): SARAH YEAGAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 NOEL DR
CENTEREACH NY
11720-2235
US

IV. Provider business mailing address

103 NOEL DR
CENTEREACH NY
11720-2235
US

V. Phone/Fax

Practice location:
  • Phone: 631-365-1533
  • Fax:
Mailing address:
  • Phone: 631-365-1533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1825182
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: