Basic Information
Provider Information
NPI: 1689333841
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PERRY
FirstName: SARAH
MiddleName: ELAINE
NamePrefix: MRS.
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 239 NORMAN RD
Address2:  
City: ROCHESTER
State: NY
PostalCode: 146231155
CountryCode: US
TelephoneNumber: 5858511066
FaxNumber:  
Practice Location
Address1: 1555 LONG POND RD
Address2:  
City: ROCHESTER
State: NY
PostalCode: 146264164
CountryCode: US
TelephoneNumber: 5857237000
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/14/2021
LastUpdateDate: 03/11/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/11/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X348844NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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