Provider Demographics
NPI:1962517250
Name:MANASCO, SANDRA LEE (DOM)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LEE
Last Name:MANASCO
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:37 LITTLE CLOUD RD
Mailing Address - Street 2:
Mailing Address - City:MORIARTY
Mailing Address - State:NM
Mailing Address - Zip Code:87035
Mailing Address - Country:US
Mailing Address - Phone:505-832-4069
Mailing Address - Fax:
Practice Address - Street 1:500 CHAMA ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108
Practice Address - Country:US
Practice Address - Phone:505-268-1939
Practice Address - Fax:505-268-1939
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM878171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist