Provider Demographics
NPI:1861403339
Name:HERNDON, SARAH E (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:HERNDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6911 SHANNON WILLOW RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-1347
Mailing Address - Country:US
Mailing Address - Phone:704-529-4101
Mailing Address - Fax:704-529-6655
Practice Address - Street 1:6911 SHANNON WILLOW RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-1347
Practice Address - Country:US
Practice Address - Phone:704-529-4101
Practice Address - Fax:704-529-6655
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-000622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903381Medicaid
2062877Medicare PIN