Provider Demographics
NPI:1073213195
Name:DEGURIAN, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:DEGURIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 TIMBERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367-1382
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:204 TIMBERLAKE DR
Practice Address - Street 2:
Practice Address - City:VENETIA
Practice Address - State:PA
Practice Address - Zip Code:15367-1382
Practice Address - Country:US
Practice Address - Phone:724-413-3895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program