Provider Demographics
NPI:1891758371
Name:MCCLOY, SANDRA ARLENE (MD)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ARLENE
Last Name:MCCLOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 E MAIN ST
Mailing Address - Street 2:STE 104
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-1450
Mailing Address - Country:US
Mailing Address - Phone:315-386-8184
Mailing Address - Fax:
Practice Address - Street 1:80 E MAIN ST
Practice Address - Street 2:STE 104
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1450
Practice Address - Country:US
Practice Address - Phone:315-386-8184
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143496207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00756978Medicaid
B82464Medicare UPIN
BB4886Medicare ID - Type Unspecified