Healthcare Provider Details

I. General information

NPI: 1457870008
Provider Name (Legal Business Name): SARA ELGHANDOUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4949 LIBERTY LANE SUITE 210
ALLENTOWN PA
18106
US

IV. Provider business mailing address

4949 LIBERTY LN STE 210
ALLENTOWN PA
18106-9063
US

V. Phone/Fax

Practice location:
  • Phone: 610-966-2676
  • Fax: 610-351-2676
Mailing address:
  • Phone: 610-966-2676
  • Fax: 610-351-2676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number05340501
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: