Provider Demographics
NPI:1174368120
Name:LEIBY, SARA NICOLE (BS, MAT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:NICOLE
Last Name:LEIBY
Suffix:
Gender:F
Credentials:BS, MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 ARDMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1376
Mailing Address - Country:US
Mailing Address - Phone:484-538-8941
Mailing Address - Fax:
Practice Address - Street 1:61 ARDMORE AVE
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-1376
Practice Address - Country:US
Practice Address - Phone:484-538-8941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program