Provider Demographics
NPI:1194471417
Name:ELMAHDI, SARA B
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:B
Last Name:ELMAHDI
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 1:3848 N 3RD AVE UNIT 1011
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3454
Mailing Address - Country:US
Mailing Address - Phone:602-561-8104
Mailing Address - Fax:
Practice Address - Street 1:3848 N 3RD AVE UNIT 1011
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3454
Practice Address - Country:US
Practice Address - Phone:602-561-8104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-24
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD01220753Medicaid