Healthcare Provider Details

I. General information

NPI: 1346667979
Provider Name (Legal Business Name): SARAH MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 WOODCROFT DR
ROCHESTER NY
14616-1421
US

IV. Provider business mailing address

120 WOODCROFT DR
ROCHESTER NY
14616-1421
US

V. Phone/Fax

Practice location:
  • Phone: 585-943-7435
  • Fax:
Mailing address:
  • Phone: 585-943-7435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number681508-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: