Provider Demographics
NPI:1780189092
Name:FIALLO, SARAH CAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:CAROL
Last Name:FIALLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:CAROL
Other - Last Name:LALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 EMBARCADERO CTR STE 1900
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3723
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:
Practice Address - Street 1:1790 BROADWAY STE 1802
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1471
Practice Address - Country:US
Practice Address - Phone:212-530-0624
Practice Address - Fax:212-867-4353
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT69293207Q00000X
NY312916207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine