Healthcare Provider Details

I. General information

NPI: 1518559152
Provider Name (Legal Business Name): VANESSA SABASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 MARTIN BLVD STE 108
MIDDLE RIVER MD
21220-4103
US

IV. Provider business mailing address

1515 MARTIN BLVD STE 108
MIDDLE RIVER MD
21220-4103
US

V. Phone/Fax

Practice location:
  • Phone: 800-354-8935
  • Fax:
Mailing address:
  • Phone: 800-354-8935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number65910015
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: