Provider Demographics
NPI:1609834423
Name:RIVERA, SARA (MS, CPNP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MS, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MAIN ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1009
Mailing Address - Country:US
Mailing Address - Phone:716-878-7386
Mailing Address - Fax:716-878-1577
Practice Address - Street 1:1001 MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1009
Practice Address - Country:US
Practice Address - Phone:716-878-7386
Practice Address - Fax:716-878-1577
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381751363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYUNIVERAOther00027334001
NY000560978001OtherBLUE CROSS
NY02712123Medicaid
Q64394Medicare UPIN
NY02712123Medicaid