Provider Demographics
NPI:1982125084
Name:MAZZONI, CANDICE MARIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:MARIE
Last Name:MAZZONI
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 1:402 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-4826
Mailing Address - Country:US
Mailing Address - Phone:732-735-5295
Mailing Address - Fax:
Practice Address - Street 1:300 W WATER ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-6692
Practice Address - Country:US
Practice Address - Phone:732-755-8640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant