Healthcare Provider Details

I. General information

NPI: 1750139887
Provider Name (Legal Business Name): SARAH CORBETT DELOACH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 WINGO WAY STE 306
MT PLEASANT SC
29464-1812
US

IV. Provider business mailing address

PO BOX 632516
CINCINNATI OH
45263-2516
US

V. Phone/Fax

Practice location:
  • Phone: 843-884-1777
  • Fax: 843-606-8000
Mailing address:
  • Phone: 888-472-0043
  • Fax: 513-653-4122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5379
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: