Provider Demographics
NPI:1023747045
Name:SANGALLI, MAKENZIE (PA-C)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:
Last Name:SANGALLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 W INTERSTATE HWY 635
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3870
Mailing Address - Country:US
Mailing Address - Phone:903-701-3240
Mailing Address - Fax:214-496-0425
Practice Address - Street 1:2851 W INTERSTATE HWY 635
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3870
Practice Address - Country:US
Practice Address - Phone:214-496-0820
Practice Address - Fax:214-496-0425
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15698363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant