Provider Demographics
NPI:1760448104
Name:LICATA, SANDRA A (DC)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:A
Last Name:LICATA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-2740
Mailing Address - Country:US
Mailing Address - Phone:585-343-5311
Mailing Address - Fax:585-343-2146
Practice Address - Street 1:542 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2740
Practice Address - Country:US
Practice Address - Phone:585-343-5311
Practice Address - Fax:585-343-2146
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor