Provider Demographics
NPI:1558633198
Name:PASSEY, SARA CAROLINE (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:CAROLINE
Last Name:PASSEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:CAROLINE
Other - Last Name:BEHNKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4125 LAWNDALE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-1885
Mailing Address - Country:US
Mailing Address - Phone:336-543-0786
Mailing Address - Fax:336-234-5411
Practice Address - Street 1:4125 LAWNDALE DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-1885
Practice Address - Country:US
Practice Address - Phone:336-543-0786
Practice Address - Fax:336-234-5411
Is Sole Proprietor?:No
Enumeration Date:2012-01-28
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60421565363A00000X
NC0010-13414363A00000X
NY016923363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03694951Medicaid