Provider Demographics
NPI:1902108962
Name:MILLER, SARA ANNE (PA)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ANNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ANNE
Other - Last Name:MIRASOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 LANSING STREET
Mailing Address - Street 2:HOSPITALIST DEPARTMENT
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1983
Mailing Address - Country:US
Mailing Address - Phone:315-567-0455
Mailing Address - Fax:315-255-7099
Practice Address - Street 1:17 LANSING ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1983
Practice Address - Country:US
Practice Address - Phone:315-255-7438
Practice Address - Fax:315-255-7099
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014356363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03333162Medicaid
NY03333162Medicaid