Provider Demographics
NPI:1932515202
Name:HANSEN, SANDRA ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:ELIZABETH
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:NUSSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5784 WIDEWATERS PKWY
Mailing Address - Street 2:FL 2
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-1890
Mailing Address - Country:US
Mailing Address - Phone:315-469-1134
Mailing Address - Fax:
Practice Address - Street 1:5784 WIDEWATERS PKWY
Practice Address - Street 2:FL 2
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-1890
Practice Address - Country:US
Practice Address - Phone:315-469-1134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328843207L00000X, 207LC0200X
GA15428207L00000X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology