Provider Demographics
NPI:1336918622
Name:GIBSON, SANDRA DEAN
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:DEAN
Last Name:GIBSON
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 1:60 LEHIGH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-1625
Mailing Address - Country:US
Mailing Address - Phone:585-354-0454
Mailing Address - Fax:888-862-4299
Practice Address - Street 1:60 LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-1625
Practice Address - Country:US
Practice Address - Phone:585-354-0454
Practice Address - Fax:888-862-4299
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-27
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi