Provider Demographics
NPI:1306233119
Name:MERCANTE, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MERCANTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LIBERTY PLZ
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-5539
Mailing Address - Country:US
Mailing Address - Phone:302-369-3311
Mailing Address - Fax:302-894-9358
Practice Address - Street 1:7 LIBERTY PLZ
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-5539
Practice Address - Country:US
Practice Address - Phone:302-369-3311
Practice Address - Fax:302-894-9358
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEM9-0000144174400000X, 1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No174400000XOther Service ProvidersSpecialist