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General NPI Number Information
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NPI Number | 1427382746
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Entity Type | Organization
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Legal Business Name | BODYSHAPING BY SANDY, INC.
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Dates
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Enumeration Date | 09/21/2009
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Last Update Date | 09/21/2009
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Provider Practice Location Address
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Address Line | 5144 SHERIDAN DR
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-4648
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Country | US
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Telephone | 716-568-0246
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Fax | 716-568-0606
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Provider Business Mailing Address
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Address Line | 5144 SHERIDAN DR
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-4648
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Country | US
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Telephone | 716-568-0246
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Fax | 716-568-0606
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MS. SANDY ANNE MANNELLA
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Credential | OWNER
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Telephone | 716-568-0246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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