Healthcare Provider Details

I. General information

NPI: 1790595304
Provider Name (Legal Business Name): TABATHA A ENCALADA LMT, CBD, CRM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 01/08/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DUBON CT
FARMINGDALE NY
11735-1031
US

IV. Provider business mailing address

28 COOPER LN
LEVITTOWN NY
11756-4810
US

V. Phone/Fax

Practice location:
  • Phone: 516-637-7216
  • Fax:
Mailing address:
  • Phone: 516-637-7216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number027799-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: