Individual
LILIANA FAZENDEIRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
34A BAY ST, SAG HARBOR, NY 11963-3104
(631) 356-2631
Mailing address
15 VALORIE RD, SOUTHAMPTON, NY 11968-2308
(631) 356-2631
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
0057821
NY
225700000X
Massage Therapist
020287
NY
Other
Enumeration date
01/25/2006
Last updated
08/22/2023
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