Provider Demographics
NPI:1740640176
Name:DAVIS, SARAH SUE
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:SUE
Last Name:DAVIS
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 1:2766 AVERY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BROOKFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:13418-2010
Mailing Address - Country:US
Mailing Address - Phone:315-939-4191
Mailing Address - Fax:
Practice Address - Street 1:2766 AVERY RD
Practice Address - Street 2:
Practice Address - City:NORTH BROOKFIELD
Practice Address - State:NY
Practice Address - Zip Code:13418-2010
Practice Address - Country:US
Practice Address - Phone:315-939-4191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY516200163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse