Provider Demographics
NPI:1205475613
Name:WILLSEY, SANDRA R
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:R
Last Name:WILLSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S STE 2500
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5509
Mailing Address - Country:US
Mailing Address - Phone:585-922-1549
Mailing Address - Fax:
Practice Address - Street 1:100 KINGS HWY S STE 2500
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-5509
Practice Address - Country:US
Practice Address - Phone:585-922-1549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator