Healthcare Provider Details

I. General information

NPI: 1639561822
Provider Name (Legal Business Name): SARA JESSICA ZATCHOK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA JESSICA WALKER PA-C

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 MCKAY CT STE 100
BOARDMAN OH
44512-5786
US

IV. Provider business mailing address

835 MCKAY CT STE 100
BOARDMAN OH
44512-5786
US

V. Phone/Fax

Practice location:
  • Phone: 330-758-4399
  • Fax: 330-758-8995
Mailing address:
  • Phone: 330-758-4399
  • Fax: 330-758-8995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004291RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: