Provider Demographics
NPI:1003162470
Name:BRANDEL, SARA NICHOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:NICHOLE
Last Name:BRANDEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:NICHOLE
Other - Last Name:DAGGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:400 RED CREEK DR
Mailing Address - Street 2:STE 120
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-4273
Mailing Address - Country:US
Mailing Address - Phone:585-334-5560
Mailing Address - Fax:585-334-0659
Practice Address - Street 1:400 RED CREEK DR STE 120
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4273
Practice Address - Country:US
Practice Address - Phone:585-334-5560
Practice Address - Fax:585-730-7500
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP84799363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04463732Medicaid