Healthcare Provider Details

I. General information

NPI: 1760242432
Provider Name (Legal Business Name): MAYER JONATHAN DANIEL SAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 04/11/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 ANDERSON ST STE 101
PITTSBURGH PA
15212-5803
US

IV. Provider business mailing address

127 ANDERSON ST STE 101
PITTSBURGH PA
15212-5803
US

V. Phone/Fax

Practice location:
  • Phone: 415-322-4151
  • Fax:
Mailing address:
  • Phone: 415-322-4151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN.519982
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: