Provider Demographics
NPI:1427166396
Name:ALLEN, SARA LEAH (PAC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LEAH
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:LEAH
Other - Last Name:GILLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:3030 N CENTRAL AVE STE 1001
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2716
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:
Practice Address - Street 1:21300 N JOHN WAYNE PKWY STE 115
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-8978
Practice Address - Country:US
Practice Address - Phone:520-426-3424
Practice Address - Fax:520-568-9560
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3507363AM0700X
WI1055363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ431627Medicaid
AZ431627Medicaid
AZ017339295Medicare PIN