Provider Demographics
NPI:1457095788
Name:SAYRE, ANTHONY JR (CAPS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:SAYRE
Suffix:JR
Gender:M
Credentials:CAPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MOORETOWN RD
Mailing Address - Street 2:
Mailing Address - City:SWEET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18656-2243
Mailing Address - Country:US
Mailing Address - Phone:570-762-2774
Mailing Address - Fax:570-477-1470
Practice Address - Street 1:18 MOORETOWN RD
Practice Address - Street 2:
Practice Address - City:SWEET VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18656-2243
Practice Address - Country:US
Practice Address - Phone:570-762-2774
Practice Address - Fax:570-477-1470
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000010215332BC3200X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030393700001Medicaid