Healthcare Provider Details

I. General information

NPI: 1124959192
Provider Name (Legal Business Name): SARA LYNN WEIDMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 PLAZA RD
KINGSTON NY
12401-2975
US

IV. Provider business mailing address

148 SCHWABIE TPKE
KERHONKSON NY
12446-1419
US

V. Phone/Fax

Practice location:
  • Phone: 845-750-7859
  • Fax:
Mailing address:
  • Phone: 845-750-7859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number359200
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: