Provider Demographics
NPI:1639617178
Name:WASSINGER, SANDRA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:WASSINGER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:KOVACEVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:20 SIAS LN
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1908
Mailing Address - Country:US
Mailing Address - Phone:585-545-0501
Mailing Address - Fax:
Practice Address - Street 1:103 CANAL LANDING BLVD
Practice Address - Street 2:SUITE 12
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-5108
Practice Address - Country:US
Practice Address - Phone:585-227-1080
Practice Address - Fax:585-723-7709
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-04
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341315363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily