Provider Demographics
NPI:1942265392
Name:SANKO, STEPHAN R (MD)
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:R
Last Name:SANKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 WHITE SPRUCE BLVD # 600
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1607
Mailing Address - Country:US
Mailing Address - Phone:585-461-5940
Mailing Address - Fax:585-242-0682
Practice Address - Street 1:125 WHITE SPRUCE BLVD # 600
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1607
Practice Address - Country:US
Practice Address - Phone:585-461-5940
Practice Address - Fax:585-242-0682
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151696207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD75364Medicare UPIN
NY16413JMedicare PIN