Provider Demographics
NPI:1780388249
Name:MOON, SIERRA DAWN (DO)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:DAWN
Last Name:MOON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ALBANY MEDICAL CENTER
Mailing Address - Street 2:DEPT OF FAMILY MEDICINE, MAIL CODE 21
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208
Mailing Address - Country:US
Mailing Address - Phone:518-264-2866
Mailing Address - Fax:
Practice Address - Street 1:ALBANY MEDICAL CENTER
Practice Address - Street 2:DEPT OF FAMILY MEDICINE, MAIL CODE 21
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208
Practice Address - Country:US
Practice Address - Phone:518-264-2866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY64798390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program