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NPI Code Detail

MEDICARE: SANDRA J MICELLI FNP

MEDICARE: SANDRA J MICELLI FNP
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
1363LF0000XFamily Nurse Practitioner333878NY

General Provider Information

NPI Number : 1679541833
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA J MICELLI FNP
Provider Business Mailing Address
First Line : 470 LONG POND RD
Second Line :
City : ROCHESTER
State : NY
Zip : 14612-3057
Country : US
Telephone Number : 585-227-7600
Fax Number : 585-227-8322
Provider Business Practice Location Address
First Line : 470 LONG POND RD
Second Line :
City : ROCHESTER
State : NY
Zip : 14612-3057
Country : US
Telephone Number : 585-227-7600
Fax Number : 585-227-8322
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 03/12/2015

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