Healthcare Provider Details

I. General information

NPI: 1568380053
Provider Name (Legal Business Name): SARA PAGE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 ROUTE 25A STE 107
SMITHTOWN NY
11787-1447
US

IV. Provider business mailing address

1350 NORTHERN BLVD STE 202
MANHASSET NY
11030-3013
US

V. Phone/Fax

Practice location:
  • Phone: 631-228-5530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number036076
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: