Provider Demographics
NPI:1164098992
Name:AYYAD, SARAH H
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:H
Last Name:AYYAD
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 1:816 BALDWIN AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-1747
Mailing Address - Country:US
Mailing Address - Phone:757-334-3106
Mailing Address - Fax:
Practice Address - Street 1:8100 THREE CHOPT RD.
Practice Address - Street 2:SUITE 143
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23229
Practice Address - Country:US
Practice Address - Phone:804-269-4732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-21-169830106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician