Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 019213-1 | NY |
NPI | 1013168541 |
---|---|
Provider Name | Shania H Dzielak |
First Address | Cicero, NY 13039 |
Second Address | Cicero, NY 13039-8337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2008 |
Last Update Date | 02/10/2008 |