Provider Demographics
NPI:1902142367
Name:SHADALLAH, SARAH LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:SHADALLAH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-1416
Mailing Address - Country:US
Mailing Address - Phone:603-238-3149
Mailing Address - Fax:603-238-9239
Practice Address - Street 1:1 WARREN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-1416
Practice Address - Country:US
Practice Address - Phone:603-238-3149
Practice Address - Fax:603-238-9239
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH060508-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3091511Medicaid