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: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 ESSJAY RD
WILLIAMSVILLE NY
14221-8216
US

IV. Provider business mailing address

6255 SHERIDAN DR SUITE 304
WILLIAMSVILLE NY
14221-4836
US

V. Phone/Fax

Practice location:
  • Phone: 716-630-1151
  • Fax: 716-250-5997
Mailing address:
  • Phone: 716-854-7866
  • Fax: 716-630-1054

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: