Healthcare Provider Details

I. General information

NPI: 1437989720
Provider Name (Legal Business Name): STYLE ICONIC, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4066 AMBOY RD
STATEN ISLAND NY
10308-2409
US

IV. Provider business mailing address

4066 AMBOY RD
STATEN ISLAND NY
10308-2409
US

V. Phone/Fax

Practice location:
  • Phone: 347-215-2975
  • Fax:
Mailing address:
  • Phone: 347-215-2975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: MARSEIL MANSI
Title or Position: OWNER/CEO/PROVIDER
Credential:
Phone: 347-261-0370