Provider Demographics
NPI:1457243073
Name:MASCIOLI, SARAH KATHERIN (NP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KATHERIN
Last Name:MASCIOLI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3569 TREELINE PASS NE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-6105
Mailing Address - Country:US
Mailing Address - Phone:678-800-8449
Mailing Address - Fax:
Practice Address - Street 1:4961 BUFORD HWY STE 201
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-3536
Practice Address - Country:US
Practice Address - Phone:770-733-1077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN324259363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty