Provider Demographics
NPI:1508272287
Name:EANNIELLO, SARAH (NP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:EANNIELLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 HILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13441-4203
Mailing Address - Country:US
Mailing Address - Phone:315-356-7390
Mailing Address - Fax:315-356-7393
Practice Address - Street 1:267 HILL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13441-4203
Practice Address - Country:US
Practice Address - Phone:315-356-7390
Practice Address - Fax:315-356-7393
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338764363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily