Provider Demographics
NPI:1295390763
Name:SADEGHI, SARA (DPM)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SADEGHI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 E WATERFRONT DR STE 230
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:PA
Mailing Address - Zip Code:15120-1151
Mailing Address - Country:US
Mailing Address - Phone:412-461-1108
Mailing Address - Fax:412-461-5490
Practice Address - Street 1:495 E WATERFRONT DR STE 230
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-1151
Practice Address - Country:US
Practice Address - Phone:412-461-1108
Practice Address - Fax:412-461-5490
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC007253213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty