Provider Demographics
NPI:1831562297
Name:MAZO, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MAZO
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 1:203 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1341
Mailing Address - Country:US
Mailing Address - Phone:912-228-0971
Mailing Address - Fax:912-376-0284
Practice Address - Street 1:203 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1341
Practice Address - Country:US
Practice Address - Phone:912-228-0971
Practice Address - Fax:912-376-0284
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-07
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No171M00000XOther Service ProvidersCase Manager/Care Coordinator