Provider Demographics
NPI:1427382746
Name:BODYSHAPING BY SANDY, INC.
Entity Type:Organization
Organization Name:BODYSHAPING BY SANDY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MANNELLA
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:716-568-0246
Mailing Address - Street 1:5144 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4648
Mailing Address - Country:US
Mailing Address - Phone:716-568-0246
Mailing Address - Fax:716-568-0606
Practice Address - Street 1:5144 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4648
Practice Address - Country:US
Practice Address - Phone:716-568-0246
Practice Address - Fax:716-568-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty