Mauricio Mendez Sandoval, OD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

1643 Route 112 Ste a
Medford, NY 11763-3654

Phone

(631) 758-5575

Fax

(631) 758-5579

NPI assigned

Nov 13, 2025

Last updated

Nov 13, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1762992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762992000000",
    "number": "1417817230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1643 ROUTE 112 STE A",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117633654",
            "telephone_number": "631-758-5575",
            "fax_number": "631-758-5579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1643 ROUTE 112 STE A",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117633654",
            "telephone_number": "631-758-5575",
            "fax_number": "631-758-5579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDEZ SANDOVAL",
        "first_name": "MAURICIO",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-11-13",
        "last_updated": "2025-11-13",
        "certification_date": "2025-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Medford Volunteer Ambulance, Inc.
• Medivault Labs
• Medpath Diagnostics Inc
• Laura Ruth Melilli, LPN
• Melissa Stockman Adult Care NP PC
• Amy Lynne Menditto
• Jasmine D Mendoza Rivera
• Lori Merck
• Trevina Metyas, DDS
• Jaclyn Michelli, CCC-SLP

• Student in an Organized Health Care Education/Training Program in Medford, NY
• Providers in Medford, NY by specialty
• Student in an Organized Health Care Education/Training Program in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.