Provider Demographics
NPI:1154742799
Name:RIZZI SQUILLACI, SANDRA (BS)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:RIZZI SQUILLACI
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8157 NW 108TH PL
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-6027
Mailing Address - Country:US
Mailing Address - Phone:786-208-8687
Mailing Address - Fax:
Practice Address - Street 1:8333 NW 53RD ST STE 450
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-4837
Practice Address - Country:US
Practice Address - Phone:786-208-8687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-28
Last Update Date:2015-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator