Provider Demographics
NPI:1437658796
Name:GREEN, SARAH JYOTI (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JYOTI
Last Name:GREEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 DARRINGTON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8158
Mailing Address - Country:US
Mailing Address - Phone:919-852-3999
Mailing Address - Fax:919-378-9114
Practice Address - Street 1:1021 DARRINGTON DR STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8158
Practice Address - Country:US
Practice Address - Phone:919-852-3999
Practice Address - Fax:919-378-9114
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
NC0010-07836363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-07836OtherNCMB