Provider Demographics
NPI:1417405119
Name:MAZZELLA, SILVIO JR (CDN)
Entity Type:Individual
Prefix:MR
First Name:SILVIO
Middle Name:
Last Name:MAZZELLA
Suffix:JR
Gender:M
Credentials:CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 OAKLAND PLACE
Mailing Address - Street 2:APT H2
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-3602
Mailing Address - Country:US
Mailing Address - Phone:718-367-7270
Mailing Address - Fax:
Practice Address - Street 1:711 OAKLAND PL
Practice Address - Street 2:APT H2
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-3602
Practice Address - Country:US
Practice Address - Phone:718-367-7270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000961-1133NN1002X, 3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider