Provider Demographics
NPI:1952126229
Name:SPAULDING, SARA EILEEN WERDEIN (FNP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:EILEEN WERDEIN
Last Name:SPAULDING
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:794 UTICA ST
Mailing Address - Street 2:
Mailing Address - City:DE RUYTER
Mailing Address - State:NY
Mailing Address - Zip Code:13052-9614
Mailing Address - Country:US
Mailing Address - Phone:585-474-7350
Mailing Address - Fax:
Practice Address - Street 1:179 N BROAD ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1097
Practice Address - Country:US
Practice Address - Phone:607-337-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF355308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily