MEDICARE: AMY SARAH FENTON PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA17871	CA

General Provider Information

NPI Number	:	1851736086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY SARAH FENTON PA

Provider Business Mailing Address
First Line	:	325 DISTEL CIR
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1408
Country	:	US
Telephone Number	:	650-617-8100
Fax Number	:	650-327-2947

Provider Business Practice Location Address
First Line	:	1950 UNIVERSITY AVENUE
Second Line	:	SUITE 160
City	:	E PALO ALTO
State	:	CA
Zip	:	94303-2285
Country	:	US
Telephone Number	:	650-617-8100
Fax Number	:	650-327-2947

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2013
Last Update Date	:	06/05/2020

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