Individual
MS. JACQUELINE DEDOMENICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
72 PARKHILL AVE, MASSAPEQUA, NY 11758-4553
(516) 840-2383
Mailing address
72 PARKHILL AVE, MASSAPEQUA, NY 11758-4553
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
015300-1
NY
Other
Enumeration date
10/02/2020
Last updated
10/02/2020
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