Healthcare Provider Details

I. General information

NPI: 1992054282
Provider Name (Legal Business Name): JANELLE GAY-LEVY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2012
Last Update Date: 09/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 GOLDEN OAKS LN
ST AUGUSTINE FL
32080-6111
US

IV. Provider business mailing address

205 GOLDEN OAKS LN
ST AUGUSTINE FL
32080-6111
US

V. Phone/Fax

Practice location:
  • Phone: 561-932-7452
  • Fax:
Mailing address:
  • Phone: 561-932-7452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 64082
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: