Healthcare Provider Details

I. General information

NPI: 1174265003
Provider Name (Legal Business Name): KATHRYN SIERRA FORTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WELLNESS WAY STE 114
LATHAM NY
12110-2467
US

IV. Provider business mailing address

6 WELLNESS WAY STE 201
LATHAM NY
12110-2156
US

V. Phone/Fax

Practice location:
  • Phone: 518-785-5881
  • Fax: 518-785-1574
Mailing address:
  • Phone: 518-782-3700
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number340327
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: