Individual
DENISE DEFAZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, LMT, CDT
Contact information
Practice address
4 SPRINGVILLE RD., HAMPTON BAYS, NY 11946-1170
(631) 682-9908
Mailing address
10 CAMBRIDGE DR, BABYLON, NY 11702-3610
(631) 682-9908
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
015779-1
NY
Other
Enumeration date
02/02/2019
Last updated
02/02/2019
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