Provider Demographics
NPI:1073956603
Name:OTWELL, SARAH L (PMHNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:L
Last Name:OTWELL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 GRIDER ST RM 1168
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3021
Mailing Address - Country:US
Mailing Address - Phone:716-898-4968
Mailing Address - Fax:716-898-4447
Practice Address - Street 1:1825 MAPLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2723
Practice Address - Country:US
Practice Address - Phone:716-886-5493
Practice Address - Fax:716-886-5835
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-13
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401582363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health