MEDICARE: PETRONELLAH MAZORODZE DNP

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	363L00000X	Nurse Practitioner	SP027006	PA
2	363L00000X	Nurse Practitioner	RN697983	PA

General Provider Information

NPI Number	:	1407563729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETRONELLAH MAZORODZE DNP

Provider Business Mailing Address
First Line	:	801 OSTRUM ST
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18015-1000
Country	:	US
Telephone Number	:	272-212-3009
Fax Number	:	866-230-5974

Provider Business Practice Location Address
First Line	:	239 E BROWN ST
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18301-3005
Country	:	US
Telephone Number	:	272-212-3872
Fax Number	:	866-230-5974

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

Provider Enumeration Date	:	11/07/2022
Last Update Date	:	01/15/2026

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