Provider Demographics
NPI:1265233720
Name:MAXIMUS, SARA GINA (PMHNP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:GINA
Last Name:MAXIMUS
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:MATHEW
Other - Last Name:MANOJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:304 BLUE RIDGE PLACE CT
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2435
Mailing Address - Country:US
Mailing Address - Phone:636-675-0815
Mailing Address - Fax:
Practice Address - Street 1:621 S NEW BALLAS RD STE 2009B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8265
Practice Address - Country:US
Practice Address - Phone:314-251-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025008397363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health