MEDICARE: MAKEBA LLOYD COMPLEMENTARY HEALTH

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		NY
2	171400000X	Health & Wellness Coach		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1982349981	OTHER	NY	PREVENTATIVE CARE PRACTITIONER

General Provider Information

NPI Number	:	1376365973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKEBA LLOYD COMPLEMENTARY HEALTH

Provider Business Mailing Address
First Line	:	4080 BROADWAY # 219
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-1572
Country	:	US
Telephone Number	:	347-674-3638
Fax Number	:	772-829-8806

Provider Business Practice Location Address
First Line	:	870 SAINT NICHOLAS AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-5215
Country	:	US
Telephone Number	:	917-886-8806
Fax Number	:

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

Provider Enumeration Date	:	10/25/2024
Last Update Date	:	10/25/2024

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