MEDICARE: SARAH A MUNDION LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	023660-1	NY

General Provider Information

NPI Number	:	1356653695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH A MUNDION LMT

Provider Business Mailing Address
First Line	:	411 E OAK ORCHARD ST
Second Line	:	UPPER
City	:	MEDINA
State	:	NY
Zip	:	14103-1610
Country	:	US
Telephone Number	:	716-949-4557
Fax Number	:

Provider Business Practice Location Address
First Line	:	2949 ELMWOOD AVE
Second Line	:	STE 202
City	:	KENMORE
State	:	NY
Zip	:	14217-1356
Country	:	US
Telephone Number	:	716-949-4557
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2010
Last Update Date	:	07/01/2010

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