Healthcare Provider Details

I. General information

NPI: 1326273376
Provider Name (Legal Business Name): SARA JEAN WOJEWODA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4917 WILLIAM ST SUITE A
LANCASTER NY
14086-3200
US

IV. Provider business mailing address

4917 WILLIAM ST SUITE A
LANCASTER NY
14086-3200
US

V. Phone/Fax

Practice location:
  • Phone: 716-706-0005
  • Fax:
Mailing address:
  • Phone: 716-706-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number022734
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: