Provider Demographics
NPI:1083837884
Name:WHITTED, SARA MARIA
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:MARIA
Last Name:WHITTED
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 1:785 W MAIN ST APT A
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2258
Mailing Address - Country:US
Mailing Address - Phone:330-842-2977
Mailing Address - Fax:
Practice Address - Street 1:785 W MAIN ST APT A
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2258
Practice Address - Country:US
Practice Address - Phone:330-842-2977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2645954Medicaid