Provider Demographics
NPI:1871868232
Name:SACKS, REEMA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:REEMA
Middle Name:
Last Name:SACKS
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 1:3105 W 15TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7700
Mailing Address - Country:US
Mailing Address - Phone:972-612-6900
Mailing Address - Fax:972-612-6956
Practice Address - Street 1:601 ZENA RUCKER RD
Practice Address - Street 2:SOUTHLAKE
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6386
Practice Address - Country:US
Practice Address - Phone:817-488-6334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2017-08-09
Deactivation Date:2012-06-13
Deactivation Code:
Reactivation Date:2012-10-26
Provider Licenses
StateLicense IDTaxonomies
TXPA07711363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical