Provider Demographics
NPI:1922382845
Name:GALLO, SARA E (PA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:GALLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:E
Other - Last Name:MOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10081 WADSWORTH PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3827
Mailing Address - Country:US
Mailing Address - Phone:303-431-5409
Mailing Address - Fax:
Practice Address - Street 1:10081 WADSWORTH PKWY STE 200
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-3827
Practice Address - Country:US
Practice Address - Phone:303-431-5409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4193363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008036977Medicaid
CT008036977Medicaid