Basic Information
| Provider Information | |||||||||
| NPI: | 1700426111 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAZZANTI | ||||||||
| FirstName: | DEVON | ||||||||
| MiddleName: | LEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 CAMELLIA RD | ||||||||
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| City: | LEVITTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190571703 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1225 WHITEHORSE MERCERVILLE RD STE 220 | ||||||||
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| City: | MERCERVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086193882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095812200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2020 | ||||||||
| LastUpdateDate: | 01/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.