Healthcare Provider Details

I. General information

NPI: 1417405119
Provider Name (Legal Business Name): SILVIO MAZZELLA JR. CDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 OAKLAND PL APT H2
BRONX NY
10457-3602
US

IV. Provider business mailing address

711 OAKLAND PLACE APT H2
BRONX NY
10457-3602
US

V. Phone/Fax

Practice location:
  • Phone: 718-367-7270
  • Fax:
Mailing address:
  • Phone: 718-367-7270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number000961-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number000961-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: