Provider Demographics
NPI:1093844334
Name:MITZNER, SANDRA BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:BETH
Last Name:MITZNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 RHINECLIFF DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-1505
Mailing Address - Country:US
Mailing Address - Phone:585-473-2273
Mailing Address - Fax:
Practice Address - Street 1:3300 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-3741
Practice Address - Country:US
Practice Address - Phone:585-865-1550
Practice Address - Fax:585-865-5219
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1513682084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00895327Medicaid
NY00895327Medicaid
NYB76372Medicare UPIN
NY00895327Medicaid