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General NPI Number Information
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NPI Number | 1912783820
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Entity Type | Individual
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Provider Name | SALLY SUNSHINE MENDOZA LMT
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Gender | Female
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Dates
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Enumeration Date | 09/06/2023
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 7100 BALTIMORE AVE STE 211
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City | COLLEGE PARK
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State | MD
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Zip | 20740-3638
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Country | US
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Telephone | 240-487-9427
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Fax |
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Provider Business Mailing Address
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Address Line | 8109 POWHATAN ST
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City | NEW CARROLLTON
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State | MD
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Zip | 20784-3535
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Country | US
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Telephone | 571-839-2243
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | M04221
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License Number State | MD
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