Healthcare Provider Details

I. General information

NPI: 1295173813
Provider Name (Legal Business Name): SANDRA HEPPEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 WOODLAND PKWY
ANGOLA NY
14006-1216
US

IV. Provider business mailing address

4 WOODLAND PKWY
ANGOLA NY
14006-1216
US

V. Phone/Fax

Practice location:
  • Phone: 716-549-7058
  • Fax:
Mailing address:
  • Phone: 716-549-7058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number237862
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: