Provider Demographics
NPI:1386323103
Name:MARCELLO, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MARCELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 S MAIN ST APT 15
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1831
Mailing Address - Country:US
Mailing Address - Phone:585-813-5817
Mailing Address - Fax:
Practice Address - Street 1:193 S MAIN ST APT 15
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1831
Practice Address - Country:US
Practice Address - Phone:585-813-5817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312647164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse