Provider Demographics
NPI:1447295662
Name:SONDERS, LESLIE (RPAC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:SONDERS
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HAGEN DRIVE
Mailing Address - Street 2:SUITE 220 THE LINDEN OAKS MEDICAL CAMPUS
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2658
Mailing Address - Country:US
Mailing Address - Phone:585-295-5302
Mailing Address - Fax:585-248-0567
Practice Address - Street 1:30 HAGEN DRIVE
Practice Address - Street 2:SUITE 220 THE LINDEN OAKS MEDICAL CAMPUS
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2658
Practice Address - Country:US
Practice Address - Phone:585-295-5302
Practice Address - Fax:585-248-0567
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9562363A00000X
NY009373363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1023187085OtherGRO GROUP
NYP019009373OtherEXCELLUS
NY117210CUOtherPREFERRED CARE
NY117210CUOtherPREFERRED CARE