Provider Demographics
NPI:1952004699
Name:BEARDSLEY-EIDE, SARA (DO)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BEARDSLEY-EIDE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF PATHOLOGY LEVEL 2- 749
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-7025
Mailing Address - Country:US
Mailing Address - Phone:631-444-2224
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF PATHOLOGY LEVEL 2- 749
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-7025
Practice Address - Country:US
Practice Address - Phone:631-444-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program