Individual
MRS. DEIDRE MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
120 ELLER AVE, BUFFALO, NY 14211-2115
(716) 292-6113
Mailing address
120 ELLER AVE, BUFFALO, NY 14211-2115
(716) 292-6113
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
017782
NY
Other
Enumeration date
07/07/2014
Last updated
07/07/2014
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