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NPI Code Detail

MEDICARE: DR. SANDRA BETH MITZNER M.D.

MEDICARE: DR. SANDRA BETH MITZNER M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0804XChild & Adolescent Psychiatry Physician151368NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093844334
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SANDRA BETH MITZNER M.D.
Provider Business Mailing Address
First Line : 75 RHINECLIFF DR
Second Line :
City : ROCHESTER
State : NY
Zip : 14618-1505
Country : US
Telephone Number : 585-473-2273
Fax Number :
Provider Business Practice Location Address
First Line : 3300 DEWEY AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14616-3741
Country : US
Telephone Number : 585-865-1550
Fax Number : 585-865-5219
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2007
Last Update Date : 07/03/2023

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