MEDICARE: ELLA SHAMES LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	007345-1	NY

General Provider Information

NPI Number	:	1073080180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLA SHAMES LMT

Provider Business Mailing Address
First Line	:	420 12TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5158
Country	:	US
Telephone Number	:	917-991-6692
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 12TH STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-1121
Country	:	US
Telephone Number	:	917-991-6692
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2018
Last Update Date	:	10/26/2018

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