Healthcare Provider Details

I. General information

NPI: 1558606376
Provider Name (Legal Business Name): SANDRA U. ANDERSON RN, BS, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CLINTON AVE S BUILDING H SUITE 135
ROCHESTER NY
14618-2668
US

IV. Provider business mailing address

2400 CLINTON AVE S BUILDING H SUITE 135
ROCHESTER NY
14618-2668
US

V. Phone/Fax

Practice location:
  • Phone: 585-341-7066
  • Fax: 585-341-7945
Mailing address:
  • Phone: 585-341-7066
  • Fax: 585-341-7945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number383655-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: