Provider Demographics
NPI:1376795567
Name:VILLALONA, SARA L (PA)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:VILLALONA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:L
Other - Last Name:GUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:7605 FOREST AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4938
Mailing Address - Country:US
Mailing Address - Phone:804-282-8510
Mailing Address - Fax:804-285-5750
Practice Address - Street 1:7605 FOREST AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4938
Practice Address - Country:US
Practice Address - Phone:804-282-8510
Practice Address - Fax:804-285-5750
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002493363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical