Healthcare Provider Details

I. General information

NPI: 1205112950
Provider Name (Legal Business Name): YELENA K ISKANDER MASSAGE THERAPY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3619 HENDERSON BLVD
TAMPA FL
33609-4501
US

IV. Provider business mailing address

3619 HENDERSON BLVD
TAMPA FL
33609-4501
US

V. Phone/Fax

Practice location:
  • Phone: 813-532-7462
  • Fax:
Mailing address:
  • Phone: 813-532-7462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberMA 46971
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 46971
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: