Individual
JESSICA MARIA FASANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, CLT, MLD-C
Contact information
Practice address
28 LILAC DR, SYOSSET, NY 11791-2815
(516) 250-4529
Mailing address
28 LILAC DR, SYOSSET, NY 11791-2815
(516) 250-4529
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
030477
NY
Other
Enumeration date
11/12/2020
Last updated
11/12/2020
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