Provider Demographics
NPI:1306065289
Name:SUGDEN, SARAH R (AUD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:R
Last Name:SUGDEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53-59 PUBLIC SQ
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2674
Mailing Address - Country:US
Mailing Address - Phone:315-786-3225
Mailing Address - Fax:315-786-3215
Practice Address - Street 1:53-59 PUBLIC SQ
Practice Address - Street 2:SUITE 100
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2674
Practice Address - Country:US
Practice Address - Phone:315-786-3225
Practice Address - Fax:315-786-3215
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001576231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02082575Medicaid
NYBB8342Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER