Healthcare Provider Details

I. General information

NPI: 1538076922
Provider Name (Legal Business Name): VANESSA LEDO MARINHO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11825 LAKE VICTORIA AVE APT 102
PALM BEACH GARDENS FL
33410
US

IV. Provider business mailing address

3502 MARIGOLD CT APT 102
WEST PALM BEACH FL
33410-2737
US

V. Phone/Fax

Practice location:
  • Phone: 561-352-2700
  • Fax:
Mailing address:
  • Phone: 323-944-4318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA84107
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: