MEDICARE: SANDRA JEAN WILLIAMS PA

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
1	363AM0700X	Medical Physician Assistant	007711	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1558397372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA JEAN WILLIAMS PA

Provider Business Mailing Address
First Line	:	89 GENESEE ST
Second Line	:	3RD FL. BK BLDG.
City	:	ROCHESTER
State	:	NY
Zip	:	14611-3201
Country	:	US
Telephone Number	:	585-368-3031
Fax Number	:	585-368-3037

Provider Business Practice Location Address
First Line	:	1561 LONG POND RD STE 303
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4135
Country	:	US
Telephone Number	:	585-368-6500
Fax Number	:	585-368-6501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	05/04/2020

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