Provider Demographics
NPI:1679517999
Name:AQUINO, SARA B (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:B
Last Name:AQUINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2061 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3953
Mailing Address - Country:US
Mailing Address - Phone:610-253-7818
Mailing Address - Fax:610-253-1764
Practice Address - Street 1:2061 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3953
Practice Address - Country:US
Practice Address - Phone:610-253-7818
Practice Address - Fax:610-253-1764
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051482363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP97991Medicare UPIN
PA479854V8GMedicare PIN