Provider Demographics
NPI:1619574647
Name:MAZZA, SEDONA KATHRYN
Entity Type:Individual
Prefix:
First Name:SEDONA
Middle Name:KATHRYN
Last Name:MAZZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 WILDROSE DR
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5115
Mailing Address - Country:US
Mailing Address - Phone:775-233-5217
Mailing Address - Fax:
Practice Address - Street 1:1513 WILDROSE DR
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5115
Practice Address - Country:US
Practice Address - Phone:775-233-5217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV39837-DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered