MEDICARE: MEEMA SPADOLA CLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)	26057	MA

General Provider Information

NPI Number	:	1033778253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEEMA SPADOLA CLC

Provider Business Mailing Address
First Line	:	2915 FORT HAMILTON PKWY APT 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-1605
Country	:	US
Telephone Number	:	917-627-9834
Fax Number	:

Provider Business Practice Location Address
First Line	:	2915 FORT HAMILTON PKWY APT 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-1605
Country	:	US
Telephone Number	:	917-627-9834
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2019
Last Update Date	:	06/11/2019

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