Healthcare Provider Details

I. General information

NPI: 1841354313
Provider Name (Legal Business Name): AMY LEA YAVOSKI DC, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 OLD TOWN LN
HALESITE NY
11743-2213
US

IV. Provider business mailing address

6 OLD TOWN LN
HALESITE NY
11743-2213
US

V. Phone/Fax

Practice location:
  • Phone: 516-810-0678
  • Fax:
Mailing address:
  • Phone: 516-810-0678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number023522-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX010160
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: