Healthcare Provider Details

I. General information

NPI: 1295832442
Provider Name (Legal Business Name): SARAH SHIDELER HENDRICKSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 E 6TH AVE
EUGENE OR
97401-2618
US

IV. Provider business mailing address

135 E 6TH AVE
EUGENE OR
97401-2618
US

V. Phone/Fax

Practice location:
  • Phone: 541-682-4013
  • Fax:
Mailing address:
  • Phone: 541-682-4013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9044
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number9044
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: