MEDICARE: SANDRA L MOSTACCIO-SWEENEY M.D.

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	207R00000X	Internal Medicine Physician	MD60166404	WA
2	207P00000X	Emergency Medicine Physician	N4603	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME0070000	OTHER	FL	FLORIDA
2	N4603	OTHER	TX	LICENSE
3	DR75934	OTHER	CO	LICENSE
4	MD60166404	OTHER	WA	LICENSE

General Provider Information

NPI Number	:	1689695199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA L MOSTACCIO-SWEENEY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1721
Second Line	:
City	:	HELOTES
State	:	TX
Zip	:	78023-1721
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 MAIN ST
Second Line	:	SUUITE 5200
City	:	DALLAS
State	:	TX
Zip	:	75201-4612
Country	:	US
Telephone Number	:	800-527-2145
Fax Number	:

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/10/2024

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