Provider Demographics
NPI:1508553157
Name:MAIOLO, SAGE MIKAYLA (DC)
Entity Type:Individual
Prefix:DR
First Name:SAGE
Middle Name:MIKAYLA
Last Name:MAIOLO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 WILLOW OAK DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32141-6503
Mailing Address - Country:US
Mailing Address - Phone:808-333-7378
Mailing Address - Fax:
Practice Address - Street 1:275 S CHARLES RICHARD BEALL BLVD STE 111A
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-3740
Practice Address - Country:US
Practice Address - Phone:386-243-0224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor