Provider Demographics
NPI:1538713466
Name:KANDAKAI, ZAZA L (MASTER HEALTH ADMIN)
Entity type:Individual
Prefix:MR
First Name:ZAZA
Middle Name:L
Last Name:KANDAKAI
Suffix:
Gender:M
Credentials:MASTER HEALTH ADMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 VETERANS HWY # C9A
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-2525
Mailing Address - Country:US
Mailing Address - Phone:718-954-1985
Mailing Address - Fax:
Practice Address - Street 1:20 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-5311
Practice Address - Country:US
Practice Address - Phone:718-954-1985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6850321251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health