Provider Demographics
NPI:1417611732
Name:ELLER, SARAH DELANE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:DELANE
Last Name:ELLER
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 1:509 5TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-5005
Mailing Address - Country:US
Mailing Address - Phone:828-781-5688
Mailing Address - Fax:
Practice Address - Street 1:7381 114TH AVE STE 405
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-5131
Practice Address - Country:US
Practice Address - Phone:727-258-5088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst