Provider Demographics
NPI:1912539602
Name:SEYLER, SARA CATHERINE
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:CATHERINE
Last Name:SEYLER
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:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:OREFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18069-0155
Mailing Address - Country:US
Mailing Address - Phone:570-460-0050
Mailing Address - Fax:610-398-9880
Practice Address - Street 1:2909 ROUTE 100 STE 110
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069-2951
Practice Address - Country:US
Practice Address - Phone:570-460-0050
Practice Address - Fax:610-398-9880
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH004809174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty