Provider Demographics
NPI:1720334634
Name:LEVASSEUR, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:LEVASSEUR
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 1:2510 OUTER CAPE ST
Mailing Address - Street 2:208
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8244
Mailing Address - Country:US
Mailing Address - Phone:386-624-2051
Mailing Address - Fax:
Practice Address - Street 1:2510 OUTER CAPE ST
Practice Address - Street 2:208
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8244
Practice Address - Country:US
Practice Address - Phone:386-624-2051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-29
Last Update Date:2012-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist