Provider Demographics
NPI:1861645087
Name:MENACHO, SARAH TAMARA (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:TAMARA
Last Name:MENACHO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:175 N. MEDICAL DRIVE EAST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132
Mailing Address - Country:US
Mailing Address - Phone:801-581-6908
Mailing Address - Fax:801-581-4385
Practice Address - Street 1:175 NORTH MEDICAL DRIVE EAST, 5TH FLOOR
Practice Address - Street 2:UNIVERSITY OF UTAH DEPARTMENT OF NEUROSURGERY
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-6908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ4955207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX347924801 (MDACC)Medicaid
TX347924801 (MDACC)Medicaid