Provider Demographics
NPI:1588891030
Name:BRUNER, SARAH JEAN (PA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:BRUNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JEAN
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:1350 MIDDLEFORD RD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3664
Mailing Address - Country:US
Mailing Address - Phone:302-628-8300
Mailing Address - Fax:302-628-8400
Practice Address - Street 1:1324 BELMONT AVE
Practice Address - Street 2:UNIT 105
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4584
Practice Address - Country:US
Practice Address - Phone:443-944-8031
Practice Address - Fax:443-944-9379
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003499363AM0700X
DEC5-0001023363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD563687ZJG5Medicare PIN