Healthcare Provider Details

I. General information

NPI: 1821052218
Provider Name (Legal Business Name): SARAH NELL RODES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WALNUT AVE SW
ROANOKE VA
24016-4719
US

IV. Provider business mailing address

16 WALNUT AVE SW
ROANOKE VA
24016-4719
US

V. Phone/Fax

Practice location:
  • Phone: 540-345-6468
  • Fax: 540-345-3204
Mailing address:
  • Phone: 540-345-6468
  • Fax: 540-345-3204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number610
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110003126
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: