Provider Demographics
NPI:1083204994
Name:BAYSAL, SARAH IZEL
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:IZEL
Last Name:BAYSAL
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 1:6903 SHANNOPIN DR APT 1417
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-2336
Mailing Address - Country:US
Mailing Address - Phone:757-748-4954
Mailing Address - Fax:
Practice Address - Street 1:6903 SHANNOPIN DR APT 1417
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-2336
Practice Address - Country:US
Practice Address - Phone:757-748-4954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC0010-11881363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program