Provider Demographics
NPI:1447993704
Name:MAZZA, DOMENICK (ND)
Entity type:Individual
Prefix:
First Name:DOMENICK
Middle Name:
Last Name:MAZZA
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 SHELBURNE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-6690
Mailing Address - Country:US
Mailing Address - Phone:802-985-8250
Mailing Address - Fax:
Practice Address - Street 1:3804 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-6690
Practice Address - Country:US
Practice Address - Phone:802-985-8250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0134175175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath