Provider Demographics
NPI:1376842310
Name:STACHOWIAK, SARA E (LMT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:STACHOWIAK
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 1:3868 E ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2001
Mailing Address - Country:US
Mailing Address - Phone:716-912-1281
Mailing Address - Fax:866-907-6157
Practice Address - Street 1:3868 E ROBINSON RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2001
Practice Address - Country:US
Practice Address - Phone:716-912-1281
Practice Address - Fax:866-907-6157
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024213174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist