MEDICARE: SANDRA MACK WILLIAMS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F330717-1	NY

General Provider Information

NPI Number	:	1225028079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA MACK WILLIAMS NP

Provider Business Mailing Address
First Line	:	7323 KENYON AVE
Second Line	:
City	:	BASOM
State	:	NY
Zip	:	14013-9802
Country	:	US
Telephone Number	:	585-542-5230
Fax Number	:	585-542-5254

Provider Business Practice Location Address
First Line	:	372 BLOOMINGDALE RD
Second Line	:
City	:	AKRON
State	:	NY
Zip	:	14001-1145
Country	:	US
Telephone Number	:	585-542-5230
Fax Number	:	585-542-5254

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	07/08/2007

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