Provider Demographics
NPI:1558397372
Name:WILLIAMS, SANDRA JEAN (PA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:89 GENESEE ST
Mailing Address - Street 2:3RD FL. BK BLDG.
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-3201
Mailing Address - Country:US
Mailing Address - Phone:585-368-3031
Mailing Address - Fax:585-368-3037
Practice Address - Street 1:1561 LONG POND RD STE 303
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4135
Practice Address - Country:US
Practice Address - Phone:585-368-6500
Practice Address - Fax:585-368-6501
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2020-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY007711363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02506412Medicaid
NYPA0028-GRP:BA0017Medicare PIN
NYDD1137-GRP:70008AMedicare PIN