Healthcare Provider Details

I. General information

NPI: 1710698519
Provider Name (Legal Business Name): FRUITFUL VIBRATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 01/25/2025
Certification Date: 01/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2871 GENESEE ST
BUFFALO NY
14225-3141
US

IV. Provider business mailing address

224 BLAINE AVE
BUFFALO NY
14208-1018
US

V. Phone/Fax

Practice location:
  • Phone: 716-939-7222
  • Fax:
Mailing address:
  • Phone: 716-939-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: IESHA JACKSON
Title or Position: MEMBER
Credential: LMT
Phone: 716-939-7222