Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 015586-1 | NY |
NPI | 1003328519 |
---|---|
Provider Name | Mrs. Brandy Lee Nicastro |
First Address | Darien Center, NY 14040-9743 |
Second Address | Darien Center, NY 14040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2017 |
Last Update Date | 25/10/2017 |