Provider Demographics
NPI:1265683627
Name:NEWBOLD, SARAH LYNNE (PA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNNE
Last Name:NEWBOLD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:LYNNE
Other - Last Name:MCCAUSLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1721 ADMIRAL TAUSSIG BLVD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23511-2802
Mailing Address - Country:US
Mailing Address - Phone:757-953-8761
Mailing Address - Fax:757-953-8779
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-8761
Practice Address - Fax:757-953-8779
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003197363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110003197OtherVA STATE LICENSE
IL085003327OtherSTATE LICENSE NUMBER