Provider Demographics
NPI:1275898330
Name:BELLO, SANDRA M (LMT 4186)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:BELLO
Suffix:
Gender:F
Credentials:LMT 4186
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COURTHOUSE LANE
Mailing Address - Street 2:SUITE 13R
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824
Mailing Address - Country:US
Mailing Address - Phone:978-204-3280
Mailing Address - Fax:
Practice Address - Street 1:2 COURTHOUSE LANE
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824
Practice Address - Country:US
Practice Address - Phone:978-204-3280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4186172V00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4186OtherLMT 4186