Provider Demographics
NPI:1225397805
Name:LEO, SARAH KATHRYN (RNNP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:KATHRYN
Last Name:LEO
Suffix:
Gender:F
Credentials:RNNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1155
Mailing Address - Country:US
Mailing Address - Phone:315-478-4185
Mailing Address - Fax:315-478-0840
Practice Address - Street 1:1226 E WATER ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1155
Practice Address - Country:US
Practice Address - Phone:315-478-4185
Practice Address - Fax:315-478-0840
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY606234163WE0003X
NYF337372363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03483589Medicaid
NYJ400074932Medicare PIN