Provider Demographics
NPI:1265855670
Name:BIRDSALL, SARANYA (CRNP)
Entity Type:Individual
Prefix:
First Name:SARANYA
Middle Name:
Last Name:BIRDSALL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SARANYA
Other - Middle Name:
Other - Last Name:PHADUNGCHEVITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:211 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-1138
Mailing Address - Country:US
Mailing Address - Phone:610-377-7174
Mailing Address - Fax:610-377-4785
Practice Address - Street 1:211 N 12TH ST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1138
Practice Address - Country:US
Practice Address - Phone:610-377-7174
Practice Address - Fax:610-377-4785
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily