Provider Demographics
NPI:1013516277
Name:MANZELLA, DAWN J (MSED)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:J
Last Name:MANZELLA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HOLMES PL
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1214
Mailing Address - Country:US
Mailing Address - Phone:716-796-7359
Mailing Address - Fax:
Practice Address - Street 1:135 W MAINN ST
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063
Practice Address - Country:US
Practice Address - Phone:716-672-2731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2416274174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist