Provider Demographics
NPI:1720692254
Name:LEFAUVE, SARAH DANIELLE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:DANIELLE
Last Name:LEFAUVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 E BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14428-8904
Mailing Address - Country:US
Mailing Address - Phone:636-779-6306
Mailing Address - Fax:
Practice Address - Street 1:14016 NY-31
Practice Address - Street 2:UNIT 101
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411
Practice Address - Country:US
Practice Address - Phone:585-589-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOX114235002390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program