Provider Demographics
NPI:1699262642
Name:KUNZ, SANDRA WALLACE (DOM)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:WALLACE
Last Name:KUNZ
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:WALLACE
Other - Last Name:MIDDLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:MAYNARD
Mailing Address - State:MA
Mailing Address - Zip Code:01754-2405
Mailing Address - Country:US
Mailing Address - Phone:978-944-2904
Mailing Address - Fax:
Practice Address - Street 1:43 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:MAYNARD
Practice Address - State:MA
Practice Address - Zip Code:01754-2405
Practice Address - Country:US
Practice Address - Phone:978-944-2904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist