Provider Demographics
NPI:1235693730
Name:MAROTTA REED, SALLY JOANNE (MS)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:JOANNE
Last Name:MAROTTA REED
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5292 CAMBRIA RD
Mailing Address - Street 2:
Mailing Address - City:SANBORN
Mailing Address - State:NY
Mailing Address - Zip Code:14132-9412
Mailing Address - Country:US
Mailing Address - Phone:716-860-2680
Mailing Address - Fax:
Practice Address - Street 1:5292 CAMBRIA RD
Practice Address - Street 2:
Practice Address - City:SANBORN
Practice Address - State:NY
Practice Address - Zip Code:14132-9412
Practice Address - Country:US
Practice Address - Phone:716-860-2680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15572080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty