Healthcare Provider Details

I. General information

NPI: 1295228641
Provider Name (Legal Business Name): SARAH L FORD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 12/31/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5877 OLD STATE RT 19
BELMONT NY
14813
US

IV. Provider business mailing address

5877 OLD STATE RT 19
BELMONT NY
14813
US

V. Phone/Fax

Practice location:
  • Phone: 585-268-5700
  • Fax: 585-320-1069
Mailing address:
  • Phone: 585-268-5700
  • Fax: 853-201-0695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number22203
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number022203
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: