MEDICARE: MS. MARIE C SARDO NP

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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	469961	NY

General Provider Information

NPI Number	:	1386637213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIE C SARDO NP

Provider Business Mailing Address
First Line	:	4567 CROSSROADS PARK DR
Second Line	:	2ND FLOOR
City	:	LIVERPOOL
State	:	NY
Zip	:	13088-3589
Country	:	US
Telephone Number	:	315-295-2100
Fax Number	:	315-295-2126

Provider Business Practice Location Address
First Line	:	14 W GENESEE ST
Second Line	:
City	:	BALDWINSVILLE
State	:	NY
Zip	:	13027-1105
Country	:	US
Telephone Number	:	315-455-5101
Fax Number	:

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	09/13/2007

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