Healthcare Provider Details

I. General information

NPI: 1396351664
Provider Name (Legal Business Name): SANDRA MARIE RIZZO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 E HOSPITAL DR
WEST COLUMBIA SC
29169-4800
US

IV. Provider business mailing address

77 THOMAS JOHNSON DR STE K
FREDERICK MD
21702-4893
US

V. Phone/Fax

Practice location:
  • Phone: 803-739-3660
  • Fax: 803-739-3663
Mailing address:
  • Phone: 301-662-4868
  • Fax: 833-989-2309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberR238737
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR238737
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number32246
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: