Provider Demographics
NPI:1639714256
Name:WALDO, SARA (CPM)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:WALDO
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 VIEW HIGH DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64134-2343
Mailing Address - Country:US
Mailing Address - Phone:816-868-1027
Mailing Address - Fax:
Practice Address - Street 1:4831 ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66203-1310
Practice Address - Country:US
Practice Address - Phone:913-735-5259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO19050007207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology