Healthcare Provider Details

I. General information

NPI: 1457539736
Provider Name (Legal Business Name): SHAWNA C. LOCASCIO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 GLENEIDA AVE STE A
CARMEL NY
10512-1222
US

IV. Provider business mailing address

91 GLENEIDA AVE STE A
CARMEL NY
10512-1222
US

V. Phone/Fax

Practice location:
  • Phone: 845-228-7000
  • Fax: 845-228-5485
Mailing address:
  • Phone: 845-228-7000
  • Fax: 845-228-5485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number017210-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: