Provider Demographics
NPI:1437372604
Name:NICHOLAS, SARA SHAW (MD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:SHAW
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 22581
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-2581
Mailing Address - Country:US
Mailing Address - Phone:610-482-4795
Mailing Address - Fax:856-528-3117
Practice Address - Street 1:780 E MARKET ST STE 105
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-4882
Practice Address - Country:US
Practice Address - Phone:610-649-9021
Practice Address - Fax:484-266-7352
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006015601207VX0000X
PAMD439496207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0293636Medicaid
PA1027138310001Medicaid
PA239901Medicare PIN