Provider Demographics
NPI:1396907598
Name:MANCO, SARAH (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MANCO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-5448
Mailing Address - Country:US
Mailing Address - Phone:914-443-7126
Mailing Address - Fax:
Practice Address - Street 1:130 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-5448
Practice Address - Country:US
Practice Address - Phone:914-443-7126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-28
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17674363LP0808X
AZAP8368363LP0808X
NYF401449-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health