Provider Demographics
NPI:1427493741
Name:SACKS, DAWN MARIE (NP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:SACKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6943 CHRISTI LN
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-3001
Mailing Address - Country:US
Mailing Address - Phone:716-216-4250
Mailing Address - Fax:
Practice Address - Street 1:3332 WALDEN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-2400
Practice Address - Country:US
Practice Address - Phone:716-668-7051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306346363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health