Healthcare Provider Details

I. General information

NPI: 1851856116
Provider Name (Legal Business Name): SARA MICHELE BUSQUE PA- C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 ALBANY SHAKER RD STE 100
ALBANY NY
12211-1962
US

IV. Provider business mailing address

407 ALBANY SHAKER RD STE 100
ALBANY NY
12211-1962
US

V. Phone/Fax

Practice location:
  • Phone: 518-435-1300
  • Fax: 518-435-1397
Mailing address:
  • Phone: 518-435-1300
  • Fax: 518-435-1397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: