Provider Demographics
NPI:1356173058
Name:SAZO, FERNANDA ANTONIA
Entity type:Individual
Prefix:
First Name:FERNANDA
Middle Name:ANTONIA
Last Name:SAZO
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 1:2050 S RIDGEWOOD AVE APT H4
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-8482
Mailing Address - Country:US
Mailing Address - Phone:786-287-5832
Mailing Address - Fax:
Practice Address - Street 1:2050 S RIDGEWOOD AVE APT H4
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-8482
Practice Address - Country:US
Practice Address - Phone:786-287-5832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer