Provider Demographics
NPI:1962121426
Name:WYCHE, SARAH (PA-C)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:
Last Name:WYCHE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 S TAMIAMI TRL STE 401
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2921
Mailing Address - Country:US
Mailing Address - Phone:941-917-0060
Mailing Address - Fax:941-957-4248
Practice Address - Street 1:1540 S TAMIAMI TRL STE 401
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2921
Practice Address - Country:US
Practice Address - Phone:941-917-0060
Practice Address - Fax:941-957-4248
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116072363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9116072OtherSTATE MEDICAL LICENSE