Provider Demographics
NPI:1508346974
Name:PATCH, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:PATCH
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 1:2929 N UNIVERSITY DR STE 110
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5047
Mailing Address - Country:US
Mailing Address - Phone:954-637-3270
Mailing Address - Fax:
Practice Address - Street 1:2929 N UNIVERSITY DR STE 110
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5047
Practice Address - Country:US
Practice Address - Phone:954-637-3270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA17379235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty