Healthcare Provider Details

I. General information

NPI: 1396874012
Provider Name (Legal Business Name): AMBER LAEL SICILIANO L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W 49TH ST SUITE 503
NEW YORK NY
10019-7400
US

IV. Provider business mailing address

3960 54TH ST APT. 9D
WOODSIDE NY
11377-4237
US

V. Phone/Fax

Practice location:
  • Phone: 347-556-2014
  • Fax:
Mailing address:
  • Phone: 347-556-2014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number020735
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: