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General NPI Number Information
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NPI Number | 1033478912
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Entity Type | Individual
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Provider Name | SARA ELIZABETH DOE P.A.
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Gender | Female
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 02/08/2019
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Provider Practice Location Address
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Address Line | 1415 PORTLAND AVE DEPARTMENT OF SURGERY
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City | ROCHESTER
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State | NY
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Zip | 14621-3038
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Country | US
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Telephone | 585-922-4715
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Fax |
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Provider Business Mailing Address
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Address Line | 100 KINGS HWY S
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City | ROCHESTER
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State | NY
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Zip | 14617-5504
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Country | US
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Telephone | 585-922-0553
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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