Most Relevant Information
Provider Data
| NPI Number: | 1003365537 |
| Provider Name: | SIRRAH MAZELLAN |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: | 009060 |
Most Important Dates
| Enumeration Date: | 09/26/2016 |
| Last Updated: | 09/26/2016 |
Provider Practice Location
350 E 146TH ST
BRONX
NY
104515702
Practice Location Phone/Fax
| Phone: | 7185850600 |
| Fax: |
Provider Mailing Location
350 E 146TH ST
BRONX
NY
104515702
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |