Individual
SARA LAUREN FETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2111
(757) 953-2828
(757) 953-0848
Mailing address
CENTRALIZED CREDENTIALS & PRIVILEGING DIRECTORATE, 554 KEILY STREET, JACKSONVILLE, FL 32212-3049
(757) 953-7550
(757) 953-0090
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
2201001400
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184853269
—
VA
Enumeration date
07/09/2009
Last updated
10/22/2019
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