Basic Information
Provider Information
NPI: 1235581372
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAHER
FirstName: SARAH
MiddleName: CLIFFORD
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 732973
Address2:  
City: DALLAS
State: TX
PostalCode: 753732973
CountryCode: US
TelephoneNumber: 8177022450
FaxNumber:  
Practice Location
Address1: 1500 S MAIN ST
Address2:  
City: FORT WORTH
State: TX
PostalCode: 761044917
CountryCode: US
TelephoneNumber: 8177023431
FaxNumber: 8179273603
Other Information
ProviderEnumerationDate: 07/12/2016
LastUpdateDate: 03/03/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/03/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LW0102X80813TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health

No ID Information.


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