Healthcare Provider Details

I. General information

NPI: 1053910596
Provider Name (Legal Business Name): SARAH XIAO JING DAO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2020
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BOILING SPRINGS RD STE 1600
SPARTANBURG SC
29303-4219
US

IV. Provider business mailing address

1330 BOILING SPRINGS RD STE 1600
SPARTANBURG SC
29303-4219
US

V. Phone/Fax

Practice location:
  • Phone: 864-582-6396
  • Fax:
Mailing address:
  • Phone: 864-582-6396
  • Fax: 648-582-1608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-12293
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3871
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: