Provider Demographics
NPI:1003320482
Name:MAYER MCKERNAN, SARA ELISABETH (LMT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ELISABETH
Last Name:MAYER MCKERNAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 HARDING RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7108
Mailing Address - Country:US
Mailing Address - Phone:716-388-1921
Mailing Address - Fax:
Practice Address - Street 1:3795 HARLEM RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14215-1954
Practice Address - Country:US
Practice Address - Phone:716-634-6272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018483225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist