Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | ||
N | 174N00000X | Lactation Consultant | 0000 |
NPI | 1164948238 |
---|---|
Provider Name | Mrs. Heather Ashley Mastro |
First Address | Dundee, NY 14837-9746 |
Second Address | Dundee, NY 14837 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2017 |
Last Update Date | 20/08/2017 |