Healthcare Provider Details

I. General information

NPI: 1164744496
Provider Name (Legal Business Name): SARA ROBIN FISHER PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 EAST ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

251 SALINA MEADOWS PKWY STE 100
SYRACUSE NY
13212-4516
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5294
  • Fax: 315-464-6330
Mailing address:
  • Phone: 315-464-2000
  • Fax: 315-464-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF382068-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: