Provider Demographics
NPI:1093378226
Name:MAHANES, SANDRA DEATON (DNP, RN, CCNS)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:DEATON
Last Name:MAHANES
Suffix:
Gender:F
Credentials:DNP, RN, CCNS
Other - Prefix:
Other - First Name:DEA
Other - Middle Name:
Other - Last Name:MAHANES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, RN, CCNS
Mailing Address - Street 1:1215 LEE ST FL 6
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1215 LEE ST FL 6
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0816
Practice Address - Country:US
Practice Address - Phone:434-924-5754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-14
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015001027364S00000X
VA0024181911364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist