Provider Demographics
NPI:1205807997
Name:OVERMOYER, SARAH ES (PAC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ES
Last Name:OVERMOYER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ES
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:455 BOSTON POST RD
Mailing Address - Street 2:STE 10
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1516
Mailing Address - Country:US
Mailing Address - Phone:860-388-9799
Mailing Address - Fax:860-388-6646
Practice Address - Street 1:455 BOSTON POST RD
Practice Address - Street 2:STE 10
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1516
Practice Address - Country:US
Practice Address - Phone:860-388-9799
Practice Address - Fax:860-388-6646
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000922363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970000586Medicare ID - Type Unspecified
P08952Medicare UPIN