Healthcare Provider Details

I. General information

NPI: 1073956603
Provider Name (Legal Business Name): SARAH L OTWELL PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2013
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 SYLVAN PKWY
BUFFALO NY
14228-1109
US

IV. Provider business mailing address

90 SYLVAN PKWY
BUFFALO NY
14228-1109
US

V. Phone/Fax

Practice location:
  • Phone: 716-562-6044
  • Fax: 833-392-1152
Mailing address:
  • Phone: 716-562-6044
  • Fax: 833-392-1152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401582
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: