Provider Demographics
NPI:1063720118
Name:MCCUTCHEON, SANDRA ZANETA (RN)
Entity type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:ZANETA
Last Name:MCCUTCHEON
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7604 MALDEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-1305
Mailing Address - Country:US
Mailing Address - Phone:631-480-0222
Mailing Address - Fax:
Practice Address - Street 1:1042 PINEBOROUGH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-7051
Practice Address - Country:US
Practice Address - Phone:800-619-5188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC347540251E00000X
NY624606163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No163W00000XNursing Service ProvidersRegistered Nurse