Healthcare Provider Details

I. General information

NPI: 1013312032
Provider Name (Legal Business Name): SARA CASTILANO GLASENAPP PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA CARSON CASTILANO PA

II. Dates (important events)

Enumeration Date: 11/03/2014
Last Update Date: 12/09/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33300 CLEVELAND CLINIC BLVD
AVON OH
44011-1172
US

IV. Provider business mailing address

33100 CLEVELAND CLINIC BLVD
AVON OH
44011-1390
US

V. Phone/Fax

Practice location:
  • Phone: 440-695-5000
  • Fax:
Mailing address:
  • Phone: 440-695-4650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.0040093
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: