Healthcare Provider Details

I. General information

NPI: 1285823401
Provider Name (Legal Business Name): SARA BOURAEE DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 COLISEUM DR SUITE 205
HAMPTON VA
23666-5963
US

IV. Provider business mailing address

1155 PROFESSIONAL DR
WILLIAMSBURG VA
23185-3329
US

V. Phone/Fax

Practice location:
  • Phone: 757-224-7605
  • Fax: 757-251-6236
Mailing address:
  • Phone: 757-220-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC005847
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103301022
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: