Healthcare Provider Details

I. General information

NPI: 1093627556
Provider Name (Legal Business Name): VIBRANT WELLNESS MIDWIFERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WALTON ST STE 1
SARATOGA SPRINGS NY
12866-2040
US

IV. Provider business mailing address

25 WALTON ST STE 1
SARATOGA SPRINGS NY
12866-2040
US

V. Phone/Fax

Practice location:
  • Phone: 518-212-7317
  • Fax: 518-430-5856
Mailing address:
  • Phone: 518-212-7317
  • Fax: 518-430-5856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: SUSAN PANTANO
Title or Position: OWNER
Credential: CNM
Phone: 518-227-4564