Provider Demographics
NPI:1104402171
Name:DONNELLY, SARA E (DC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 ANNAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1028
Mailing Address - Country:US
Mailing Address - Phone:410-697-3566
Mailing Address - Fax:410-697-3567
Practice Address - Street 1:959 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1028
Practice Address - Country:US
Practice Address - Phone:410-697-3566
Practice Address - Fax:410-697-3566
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor