Provider Demographics
NPI:1376869388
Name:ZACK, SANNO ELENA (PHD)
Entity Type:Individual
Prefix:MS
First Name:SANNO
Middle Name:ELENA
Last Name:ZACK
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:401 QUARRY ROAD
Mailing Address - Street 2:STANFORD MEDICAL CENTER, DEPT PSYCHIATRY
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5722
Mailing Address - Country:US
Mailing Address - Phone:650-723-6308
Mailing Address - Fax:650-723-9807
Practice Address - Street 1:401 QUARRY ROAD
Practice Address - Street 2:STANFORD MEDICAL CENTER, DEPT PSYCHIATRY
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5722
Practice Address - Country:US
Practice Address - Phone:650-723-6308
Practice Address - Fax:650-723-9807
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY23460103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical