Provider Demographics
NPI:1205397411
Name:MAZZELLA, SANDRA N (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:N
Last Name:MAZZELLA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 MASONS MILL RD STE 305
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-3517
Mailing Address - Country:US
Mailing Address - Phone:215-938-7730
Mailing Address - Fax:
Practice Address - Street 1:3501 MASONS MILL RD STE 503
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-3517
Practice Address - Country:US
Practice Address - Phone:215-938-7730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020191363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner