Provider Demographics
NPI:1649376039
Name:AUSTIN-WILSON, SARA F (RPA-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:F
Last Name:AUSTIN-WILSON
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3242 AMBER RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-9740
Mailing Address - Country:US
Mailing Address - Phone:315-673-9293
Mailing Address - Fax:315-464-9635
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:PRETESTING
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2306
Practice Address - Country:US
Practice Address - Phone:315-464-9648
Practice Address - Fax:315-464-9635
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007742-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant