Provider Demographics
NPI:1407950645
Name:FISCHER-KIERECKI, SANDRA A (CNM)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:FISCHER-KIERECKI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:A
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1415 PORTLAND AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3038
Mailing Address - Country:US
Mailing Address - Phone:585-922-4200
Mailing Address - Fax:585-922-4922
Practice Address - Street 1:1415 PORTLAND AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3038
Practice Address - Country:US
Practice Address - Phone:585-922-4200
Practice Address - Fax:585-922-4922
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000730367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01797126Medicaid
NY01797126Medicaid
NYS47599Medicare UPIN