Provider Demographics
NPI:1447442728
Name:SMITH, SARAH MATHILDE (LMT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MATHILDE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MUMFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14511-0282
Mailing Address - Country:US
Mailing Address - Phone:585-538-9390
Mailing Address - Fax:585-538-9390
Practice Address - Street 1:1037 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MUMFORD
Practice Address - State:NY
Practice Address - Zip Code:14511-0282
Practice Address - Country:US
Practice Address - Phone:585-538-9390
Practice Address - Fax:585-538-9390
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016475174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist