Provider Demographics
NPI:1790779619
Name:SCHNEIDMILLER, SARA WEBER (PHD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:WEBER
Last Name:SCHNEIDMILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 SANDY CROSS RD
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-7820
Mailing Address - Country:US
Mailing Address - Phone:336-394-4503
Mailing Address - Fax:
Practice Address - Street 1:546 SANDY CROSS RD
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-7820
Practice Address - Country:US
Practice Address - Phone:336-394-4503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1626103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000645Medicaid
NC0423JOtherBCBS NC
680012317Medicare PIN
2812333EMedicare PIN