Provider Demographics
NPI:1558606376
Name:ANDERSON, SANDRA U (RN, BS, CDE)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:U
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN, BS, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 CLINTON AVE S
Mailing Address - Street 2:BUILDING H SUITE 135
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2668
Mailing Address - Country:US
Mailing Address - Phone:585-341-7066
Mailing Address - Fax:585-341-7945
Practice Address - Street 1:2400 CLINTON AVE S
Practice Address - Street 2:BUILDING H SUITE 135
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2668
Practice Address - Country:US
Practice Address - Phone:585-341-7066
Practice Address - Fax:585-341-7945
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY383655-1163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator