Provider Demographics
NPI:1184279838
Name:SANDRA BOEBEL, PSYCHIATRIC NP, PLLC
Entity type:Organization
Organization Name:SANDRA BOEBEL, PSYCHIATRIC NP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:585-337-0817
Mailing Address - Street 1:150 ADELAIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1502
Mailing Address - Country:US
Mailing Address - Phone:585-329-3179
Mailing Address - Fax:
Practice Address - Street 1:7353 NY ROUTE 96
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1456
Practice Address - Country:US
Practice Address - Phone:585-337-0817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANDRA BOEBEL, PSYCHIATRIC NP, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-08
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF401700-1OtherNP LICENSE
NYF401700-1OtherNP LICENCE #