Provider Demographics
NPI:1053991307
Name:MORAN, SARA MICHAEL
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MICHAEL
Last Name:MORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-2541
Mailing Address - Country:US
Mailing Address - Phone:315-895-7471
Mailing Address - Fax:315-895-5255
Practice Address - Street 1:111 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:ILION
Practice Address - State:NY
Practice Address - Zip Code:13357-2541
Practice Address - Country:US
Practice Address - Phone:315-895-7471
Practice Address - Fax:315-895-5525
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY704500163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse