Basic Information
| Provider Information | |||||||||
| NPI: | 1316933880 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAKLAD-COSTELLO | ||||||||
| FirstName: | CHRISTI | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 940 SUMNEYTOWN PIKE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | SPRINGHOUSE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155420655 | ||||||||
| FaxNumber: | 2155421448 | ||||||||
| Practice Location | |||||||||
| Address1: | 8 OFFICE PARK DR | ||||||||
| Address2: | |||||||||
| City: | PALM COAST | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321373808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3868646005 | ||||||||
| FaxNumber: | 3868646110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 07/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MA051738 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 363AM0700X | MA051738 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | MA051738 | 01 | PA | PA STATE LICENSE# | OTHER |