Healthcare Provider Details

I. General information

NPI: 1639148315
Provider Name (Legal Business Name): CYNTHIA SANDERS INGALLS RPAC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MS. CYNTHIA SANDERS

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 PARISH ST SANDS CANCER CENTER
CANANDAIGUA NY
14424
US

IV. Provider business mailing address

211 WHITE SPRUCE BLVD INTERLAKES ONCOLOGY & HEMATOLOGY PC
ROCHESTER NY
14623
US

V. Phone/Fax

Practice location:
  • Phone: 585-393-7040
  • Fax: 585-394-4218
Mailing address:
  • Phone: 585-475-8728
  • Fax: 585-475-9411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number005389-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: