Provider Demographics
NPI:1043977580
Name:GADDY, SARA DENISE (RN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:DENISE
Last Name:GADDY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 SNEEDSBORO RD
Mailing Address - Street 2:
Mailing Address - City:MORVEN
Mailing Address - State:NC
Mailing Address - Zip Code:28119-8419
Mailing Address - Country:US
Mailing Address - Phone:704-690-2216
Mailing Address - Fax:
Practice Address - Street 1:207 SNEEDSBORO RD
Practice Address - Street 2:
Practice Address - City:MORVEN
Practice Address - State:NC
Practice Address - Zip Code:28119-8419
Practice Address - Country:US
Practice Address - Phone:704-690-2216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC260102163W00000X
NY823954-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse