Provider Demographics
NPI:1902456940
Name:EARLY, SARAH LATASHA
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LATASHA
Last Name:EARLY
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 1:70 SHORT BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-4635
Mailing Address - Country:US
Mailing Address - Phone:540-307-1077
Mailing Address - Fax:
Practice Address - Street 1:70 SHORT BRANCH RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-4635
Practice Address - Country:US
Practice Address - Phone:540-307-1077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide