Provider Demographics
NPI:1508920091
Name:NEILLY, SARAH ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ANNE
Last Name:NEILLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 OAK ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3111
Mailing Address - Country:US
Mailing Address - Phone:321-723-4723
Mailing Address - Fax:321-727-1448
Practice Address - Street 1:1350 HICKORY ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3224
Practice Address - Country:US
Practice Address - Phone:321-434-4225
Practice Address - Fax:321-434-4247
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94662207L00000X, 207LC0200X, 208M00000X
MA73696207L00000X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM2015OtherMEDICARE
FLPENDINGMedicaid