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General NPI Number Information
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NPI Number | 1326315821
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Entity Type | Organization
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Legal Business Name | SURREAL SERENITY MASSAGE THERAPY, LLC.
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 519 BEACH 66TH ST STE 3
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City | ARVERNE
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State | NY
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Zip | 11692-1330
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Country | US
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Telephone | 917-650-6857
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Fax |
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Provider Business Mailing Address
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Address Line | 519 BEACH 66TH STREET, SUITE 3
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City | ARVERNE
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State | NY
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Zip | 11692-1330
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Country | US
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Telephone | 917-650-6857
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. SHEREE T. SOPHAS
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Credential | LMT
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Telephone | 917-650-6857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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