Healthcare Provider Details

I. General information

NPI: 1083487599
Provider Name (Legal Business Name): CATHEDRAL LEDGE AESTHETICS AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 TECHNOLOGY LN STE 105
CONWAY NH
03818-0299
US

IV. Provider business mailing address

PO BOX 308
CONWAY NH
03818-0308
US

V. Phone/Fax

Practice location:
  • Phone: 603-662-2557
  • Fax:
Mailing address:
  • Phone: 603-662-2557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: SOHAIB SIDDIQUI
Title or Position: OWNER
Credential:
Phone: 603-662-2557