Provider Demographics
NPI:1730667981
Name:WEHLE, SARAH ANN (MS PA-C, MS RDN)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ANN
Last Name:WEHLE
Suffix:
Gender:F
Credentials:MS PA-C, MS RDN
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ANN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS RDN
Mailing Address - Street 1:10454 W SILVER CITY CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8000
Mailing Address - Country:US
Mailing Address - Phone:631-875-7501
Mailing Address - Fax:
Practice Address - Street 1:1000 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4927
Practice Address - Country:US
Practice Address - Phone:631-376-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV39119-DI-0133VN1004X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric