Provider Demographics
NPI:1356653695
Name:MUNDION, SARAH A (LMT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:MUNDION
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 1:411 E OAK ORCHARD ST
Mailing Address - Street 2:UPPER
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-1610
Mailing Address - Country:US
Mailing Address - Phone:716-949-4557
Mailing Address - Fax:
Practice Address - Street 1:2949 ELMWOOD AVE
Practice Address - Street 2:STE 202
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1356
Practice Address - Country:US
Practice Address - Phone:716-949-4557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023660-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist