Provider Demographics
NPI:1770540411
Name:WEATHERUP, SAUNDRA Y (LCSWR BCD SAP DABFSW)
Entity type:Individual
Prefix:MS
First Name:SAUNDRA
Middle Name:Y
Last Name:WEATHERUP
Suffix:
Gender:F
Credentials:LCSWR BCD SAP DABFSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SAGAMORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617
Mailing Address - Country:US
Mailing Address - Phone:585-467-3751
Mailing Address - Fax:585-756-9682
Practice Address - Street 1:225 SAGAMORE DRIVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617
Practice Address - Country:US
Practice Address - Phone:585-467-3751
Practice Address - Fax:585-756-9682
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037518R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY015730195Medicaid
B115790Medicare ID - Type Unspecified
NY015730195Medicaid