MEDICARE: DR. SANDY GAIL PHELPS-CANZONE D.O.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	671RX1	NM

General Provider Information

NPI Number	:	1184636698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDY GAIL PHELPS-CANZONE D.O.M.

Provider Business Mailing Address
First Line	:	2074 GALISTEO ST
Second Line	:	UNIT A2
City	:	SANTA FE
State	:	NM
Zip	:	87505-2138
Country	:	US
Telephone Number	:	505-989-7418
Fax Number	:	505-986-8874

Provider Business Practice Location Address
First Line	:	2074 GALISTEO ST
Second Line	:	UNIT A2
City	:	SANTA FE
State	:	NM
Zip	:	87505-2138
Country	:	US
Telephone Number	:	505-989-7418
Fax Number	:	505-986-8874

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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