Provider Demographics
NPI:1285624726
Name:SIAK, SARAH (PAC MPAS)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SIAK
Suffix:
Gender:F
Credentials:PAC MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 692049
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32869-2049
Mailing Address - Country:US
Mailing Address - Phone:407-846-7546
Mailing Address - Fax:407-933-1001
Practice Address - Street 1:725 E OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4591
Practice Address - Country:US
Practice Address - Phone:407-846-7546
Practice Address - Fax:407-933-1001
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101340363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q42126Medicare UPIN
U4620AMedicare ID - Type Unspecified