Healthcare Provider Details

I. General information

NPI: 1295448728
Provider Name (Legal Business Name): TIKISHA NEGRON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 MONTAUK HWY STE 5
MASTIC NY
11950-2934
US

IV. Provider business mailing address

1135 MONTAUK HWY STE 5
MASTIC NY
11950-2934
US

V. Phone/Fax

Practice location:
  • Phone: 516-254-1835
  • Fax:
Mailing address:
  • Phone: 516-254-1835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: