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General NPI Number Information
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NPI Number | 1336918622
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Entity Type | Individual
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Provider Name | SANDRA DEAN GIBSON
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Gender | Female
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Dates
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Enumeration Date | 12/27/2023
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 60 LEHIGH AVE
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City | ROCHESTER
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State | NY
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Zip | 14619-1625
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Country | US
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Telephone | 585-354-0454
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Fax | 888-862-4299
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Provider Business Mailing Address
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Address Line | 60 LEHIGH AVE
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City | ROCHESTER
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State | NY
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Zip | 14619-1625
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Country | US
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Telephone | 585-354-0454
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Fax | 888-862-4299
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number |
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License Number State |
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