Provider Demographics
NPI:1619363702
Name:WIESE, SARAH LEAHY (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LEAHY
Last Name:WIESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:M
Other - Last Name:LEAHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2240 NORTH FOREST ROAD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-639-4034
Mailing Address - Fax:716-929-8940
Practice Address - Street 1:2240 NORTH FOREST ROAD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-639-4034
Practice Address - Fax:716-929-8940
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299057207V00000X
MA264021207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology