Healthcare Provider Details

I. General information

NPI: 1447162151
Provider Name (Legal Business Name): JAYCIE LYNN MOSHER R-DMT, LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14C NORTH CARTWRIGHT RD
SHELTER ISLAND NY
11964
US

IV. Provider business mailing address

41 VASSAR PL
ROCKVILLE CENTRE NY
11570-2830
US

V. Phone/Fax

Practice location:
  • Phone: 516-547-3994
  • Fax:
Mailing address:
  • Phone: 516-547-3994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number003330
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: