Provider Demographics
NPI:1992172811
Name:BERRY, SARAH (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BERRY
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 1:1700 SUMMER ST
Mailing Address - Street 2:APT B 38
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-2594
Mailing Address - Country:US
Mailing Address - Phone:717-805-5249
Mailing Address - Fax:
Practice Address - Street 1:220 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2838
Practice Address - Country:US
Practice Address - Phone:931-684-2802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2822363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant