Provider Demographics
NPI:1225670367
Name:ROUSAKIS, SARAH (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:ROUSAKIS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 UNIVERSITY WOODS DR STE 8
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2427
Mailing Address - Country:US
Mailing Address - Phone:812-944-7500
Mailing Address - Fax:812-944-4656
Practice Address - Street 1:825 UNIVERSITY WOODS DR STE 8
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2427
Practice Address - Country:US
Practice Address - Phone:812-944-7500
Practice Address - Fax:812-944-4656
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10002819A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10002819AOtherINDIANA LICENSE