Provider Demographics
NPI:1760975767
Name:O'BRIEN, SARAH ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ELIZABETH
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:ELIZABETH
Other - Last Name:NICOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:47 NEW SCOTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208
Mailing Address - Country:US
Mailing Address - Phone:518-262-5226
Mailing Address - Fax:518-262-6261
Practice Address - Street 1:47 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208
Practice Address - Country:US
Practice Address - Phone:518-262-5226
Practice Address - Fax:518-262-6261
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY745357163W00000X
NY343368363LF0000X, 363LF0000X
VA0001270817163WN0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05323602Medicaid
NY343368OtherNEW YORK STATE OFFICE OF THE PROFESSIONS