Healthcare Provider Details

I. General information

NPI: 1447657192
Provider Name (Legal Business Name): DORI FORTUNATO DAOM, LIC. AC. LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 MONTAUK HWY
BRIDGEHAMPTON NY
11932-4001
US

IV. Provider business mailing address

PO BOX 1142
SHELTER ISLAND HEIGHTS NY
11965-1142
US

V. Phone/Fax

Practice location:
  • Phone: 631-500-5452
  • Fax:
Mailing address:
  • Phone: 631-374-2728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number27027339
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25005472
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: