=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083701569
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRA L NEUBAUER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2006
-----------------------------------------------------
Last Update Date | 07/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 626 N FRENCH RD STE 5
-----------------------------------------------------
City | AMHERST
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14228-2105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-564-3600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 913 SLIKER RD
-----------------------------------------------------
City | CORFU
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14036-9796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-409-6909
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | 420274
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------