Healthcare Provider Details

I. General information

NPI: 1083998199
Provider Name (Legal Business Name): DEBORAH MARY SANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX E
LIVONIA NY
14487-0489
US

IV. Provider business mailing address

PO BOX E
LIVONIA NY
14487-0489
US

V. Phone/Fax

Practice location:
  • Phone: 585-346-4000
  • Fax: 585-346-4053
Mailing address:
  • Phone: 585-346-4000
  • Fax: 585-346-4053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number548393-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: