Healthcare Provider Details

I. General information

NPI: 1942677646
Provider Name (Legal Business Name): SARAH BRESHEARS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 N OLD MOUNT JULIET ROAD
MOUNT JULIET TN
37122
US

IV. Provider business mailing address

2802 VALLEY RD
NASHVILLE TN
37215-1220
US

V. Phone/Fax

Practice location:
  • Phone: 615-758-4888
  • Fax:
Mailing address:
  • Phone: 918-637-0186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5668
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: