Provider Demographics
NPI:1285129320
Name:MOONEY, SARAH CHRISTINE (FNP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:CHRISTINE
Last Name:MOONEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:CHRISTINE
Other - Last Name:MOONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:5547 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NY
Mailing Address - Zip Code:13478-3426
Mailing Address - Country:US
Mailing Address - Phone:315-363-3482
Mailing Address - Fax:315-363-1597
Practice Address - Street 1:5547 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NY
Practice Address - Zip Code:13478-3426
Practice Address - Country:US
Practice Address - Phone:315-363-3482
Practice Address - Fax:315-363-1597
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-343042-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05357834Medicaid