Provider Demographics
NPI:1902980642
Name:WAHBA, SARA (MD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:WAHBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 NE 2ND ST
Mailing Address - Street 2:# 23
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33429-5001
Mailing Address - Country:US
Mailing Address - Phone:561-322-6547
Mailing Address - Fax:
Practice Address - Street 1:170 NE 2ND ST
Practice Address - Street 2:# 23
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33429-5001
Practice Address - Country:US
Practice Address - Phone:561-322-6547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 96596207Q00000X
FLME96596207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2756392OtherUNITED HEALTH CARE
FL276941700Medicaid
FL90829OtherBLUE CROSS BLUE SHIELD
FL276941700Medicaid