Provider Demographics
NPI:1457870008
Name:ELGHANDOUR, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ELGHANDOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 LIBERTY LN STE 210
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9063
Mailing Address - Country:US
Mailing Address - Phone:610-966-2676
Mailing Address - Fax:610-351-2676
Practice Address - Street 1:4949 LIBERTY LANE
Practice Address - Street 2:SUITE 210
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106
Practice Address - Country:US
Practice Address - Phone:610-966-2676
Practice Address - Fax:610-351-2676
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05340501163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPN301044Medicaid