Provider Demographics
NPI:1275693053
Name:DANIELSON, SARAH VADEN (PA)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:VADEN
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1300 E 15TH ST STE 130
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5051
Mailing Address - Country:US
Mailing Address - Phone:405-665-8787
Mailing Address - Fax:888-329-0731
Practice Address - Street 1:1300 E 15TH ST STE 130
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5051
Practice Address - Country:US
Practice Address - Phone:405-665-8787
Practice Address - Fax:888-329-0731
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKPA8642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD42917Medicare UPIN