Healthcare Provider Details

I. General information

NPI: 1063756807
Provider Name (Legal Business Name): ELIZABETH ROSE MASIELLO DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2012
Last Update Date: 11/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4126 ANNAS RETREAT
ST THOMAS VI
00802-1760
US

IV. Provider business mailing address

4126 ANNAS RETREAT
ST THOMAS VI
00802-1760
US

V. Phone/Fax

Practice location:
  • Phone: 340-715-1361
  • Fax: 340-714-5413
Mailing address:
  • Phone: 340-715-1361
  • Fax: 340-714-5413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0025
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: