Provider Demographics
NPI:1033111323
Name:SENGEL, SARA JANE (PA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JANE
Last Name:SENGEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 N WICKHAM RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2028
Mailing Address - Country:US
Mailing Address - Phone:321-253-2169
Mailing Address - Fax:321-253-1720
Practice Address - Street 1:6300 N WICKHAM RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2028
Practice Address - Country:US
Practice Address - Phone:321-253-2169
Practice Address - Fax:321-253-1720
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3556363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291735100Medicaid
FLU3321YMedicare ID - Type UnspecifiedGROUP # 45368
FL291735100Medicaid
FLU3321ZMedicare ID - Type UnspecifiedGROUP # 34457