Healthcare Provider Details

I. General information

NPI: 1255482766
Provider Name (Legal Business Name): SANDRA JANE ELLER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WHITE SPRUCE BLVD
ROCHESTER NY
14623-1605
US

IV. Provider business mailing address

200 WHITE SPRUCE BLVD
ROCHESTER NY
14623-1605
US

V. Phone/Fax

Practice location:
  • Phone: 585-427-0270
  • Fax: 585-427-0270
Mailing address:
  • Phone: 585-427-0270
  • Fax: 585-427-0270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7743-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number7743-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: