Provider Demographics
NPI:1629543566
Name:DIBENEDETTO, SARAH WHITNEY (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:WHITNEY
Last Name:DIBENEDETTO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:MOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4815 LIBERTY AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-235-5900
Mailing Address - Fax:412-235-5901
Practice Address - Street 1:4815 LIBERTY AVE STE 215
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-235-5900
Practice Address - Fax:412-235-5901
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060274363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103604448Medicaid
14418513OtherCAQH