Healthcare Provider Details

I. General information

NPI: 1336764612
Provider Name (Legal Business Name): SADIE DONIGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 WINONA BLVD
ROCHESTER NY
14617-2956
US

IV. Provider business mailing address

934 WINONA BLVD
ROCHESTER NY
14617-2956
US

V. Phone/Fax

Practice location:
  • Phone: 315-944-8734
  • Fax:
Mailing address:
  • Phone: 315-944-8734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number769234
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: