Provider Demographics
NPI:1003059312
Name:UDANI, SARA ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:UDANI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ELIZABETH
Other - Last Name:WOLSCHLAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10150 HIGHLAND MANOR DR STE 205
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-9727
Mailing Address - Country:US
Mailing Address - Phone:813-259-1013
Mailing Address - Fax:813-254-0396
Practice Address - Street 1:10150 HIGHLAND MANOR DR STE 205
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-9727
Practice Address - Country:US
Practice Address - Phone:813-259-1013
Practice Address - Fax:813-254-0396
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2152133V00000X
FLPA9115320363A00000X, 207P00000X
LAPA.200635RX363A00000X
IL085.005538363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3B062Medicare PIN
LA3B0627061Medicare PIN