Healthcare Provider Details

I. General information

NPI: 1467792168
Provider Name (Legal Business Name): SANDRA JOAN MICHEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2013
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3332 WALDEN AVE STE 110
DEPEW NY
14043-2400
US

IV. Provider business mailing address

3332 WALDEN AVE STE 110
DEPEW NY
14043-2400
US

V. Phone/Fax

Practice location:
  • Phone: 716-668-7051
  • Fax: 716-668-7069
Mailing address:
  • Phone: 716-668-7051
  • Fax: 716-668-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number306327
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: