Healthcare Provider Details

I. General information

NPI: 1437540796
Provider Name (Legal Business Name): JACOB R. SAKIEY P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KNOTBREAK RD
SALEM VA
24153-5414
US

IV. Provider business mailing address

100 KNOTBREAK RD
SALEM VA
24153-5414
US

V. Phone/Fax

Practice location:
  • Phone: 540-444-5670
  • Fax:
Mailing address:
  • Phone: 540-444-5670
  • Fax: 540-444-5669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110004829
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: