Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | LJ-0000349 | DE |
NPI | 1083185367 |
---|---|
Provider Name | Sarah Jane Garraty |
First Address | Rehoboth Beach, DE 19971-4476 |
Second Address | Rehoboth Beach, DE 19971-4476 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2018 |
Last Update Date | 11/12/2018 |