Provider Demographics
NPI:1598273484
Name:MOJAZZA, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MOJAZZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7012 BAYOU CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-0200
Mailing Address - Country:US
Mailing Address - Phone:801-682-6510
Mailing Address - Fax:
Practice Address - Street 1:2108 CAPITAL DR STE 102
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-6477
Practice Address - Country:US
Practice Address - Phone:801-682-6510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-14
Last Update Date:2024-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant