Sandra Boebel, Psychiatric NP, PLLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

SANDRA BOEBEL, PSYCHIATRIC NP, PLLC

Practice address

7353 Ny Route 96
Victor, NY 14564-1456

Phone

(585) 337-0817

NPI assigned

Aug 8, 2019

Organization subpart

Yes

Parent organization

SANDRA BOEBEL, PSYCHIATRIC NP, PLLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sandra Boebel, PMHNP-BCNPI 1679987440

Title

NP

Phone

(585) 337-0817

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Part of

Sandra Boebel Psychiatric NP PLLC

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sandra Boebel, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Victor, NY
  • NPI 1679987440
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577664000000",
    "number": "1184279838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 ADELAIDE AVE",
            "city": "CANANDAIGUA",
            "state": "NY",
            "postal_code": "144241502",
            "telephone_number": "585-329-3179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7353 NY ROUTE 96",
            "city": "VICTOR",
            "state": "NY",
            "postal_code": "145641456",
            "telephone_number": "585-337-0817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDRA BOEBEL, PSYCHIATRIC NP, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SANDRA BOEBEL, PSYCHIATRIC NP, PLLC",
        "enumeration_date": "2019-08-08",
        "last_updated": "2019-12-30",
        "certification_date": "2019-12-30",
        "status": "A",
        "authorized_official_last_name": "BOEBEL",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "NP",
        "authorized_official_telephone_number": "585-337-0817",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NP LICENSE",
            "identifier": "F401700-1",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NP LICENCE #",
            "identifier": "F401700-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Victor, NY
• Providers in Victor, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.