Healthcare Provider Details

I. General information

NPI: 1093378226
Provider Name (Legal Business Name): SANDRA DEATON MAHANES DNP, RN, CCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEA MAHANES DNP, RN, CCNS

II. Dates (important events)

Enumeration Date: 04/14/2019
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST FL 6
CHARLOTTESVILLE VA
22908-0816
US

IV. Provider business mailing address

1215 LEE ST FL 6
CHARLOTTESVILLE VA
22908-0816
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-5754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number0015001027
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number0024181911
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: