Provider Demographics
NPI:1316458979
Name:VENNARD, SARA (PA)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:VENNARD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:130 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:COBLESKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12043
Mailing Address - Country:US
Mailing Address - Phone:518-255-5225
Mailing Address - Fax:518-255-5819
Practice Address - Street 1:130 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043
Practice Address - Country:US
Practice Address - Phone:518-255-5225
Practice Address - Fax:518-255-5819
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021567363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05001863Medicaid