Provider Demographics
NPI:1679987440
Name:BOEBEL, SANDRA (NP)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:BOEBEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401700-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03931202Medicaid
NYF401700-1OtherNP LICENSE