Provider Demographics
NPI:1083957005
Name:ABOU JAOUDE, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:ABOU JAOUDE
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 1:475 48TH AVE APT 604
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5508
Mailing Address - Country:US
Mailing Address - Phone:347-221-4503
Mailing Address - Fax:
Practice Address - Street 1:822 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4146
Practice Address - Country:US
Practice Address - Phone:718-466-6551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057720-1183500000X
VA0202208618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist