Provider Demographics
NPI:1447935549
Name:WILTSHIRE, SARA ANNE (LSA-SURGICAL ASSIST)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ANNE
Last Name:WILTSHIRE
Suffix:
Gender:F
Credentials:LSA-SURGICAL ASSIST
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ANNE
Other - Last Name:KUNNARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5171 SHARON DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-6109
Mailing Address - Country:US
Mailing Address - Phone:757-619-8248
Mailing Address - Fax:
Practice Address - Street 1:3636 HIGH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3236
Practice Address - Country:US
Practice Address - Phone:757-398-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0136000815208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery