Provider Demographics
NPI:1417610726
Name:SAVERCOOL, SIERRA LYNN
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:LYNN
Last Name:SAVERCOOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 CAMP MINEOLA RD
Mailing Address - Street 2:
Mailing Address - City:MATTITUCK
Mailing Address - State:NY
Mailing Address - Zip Code:11952-2150
Mailing Address - Country:US
Mailing Address - Phone:216-406-2890
Mailing Address - Fax:
Practice Address - Street 1:3605 CAMP MINEOLA RD
Practice Address - Street 2:
Practice Address - City:MATTITUCK
Practice Address - State:NY
Practice Address - Zip Code:11952-2150
Practice Address - Country:US
Practice Address - Phone:216-406-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer