MEDICARE: AMBER LAEL SICILIANO L.M.T.

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	020735	NY

General Provider Information

NPI Number	:	1396874012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER LAEL SICILIANO L.M.T.

Provider Business Mailing Address
First Line	:	3960 54TH ST
Second Line	:	APT. 9D
City	:	WOODSIDE
State	:	NY
Zip	:	11377-4237
Country	:	US
Telephone Number	:	347-556-2014
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 W 49TH ST
Second Line	:	SUITE 503
City	:	NEW YORK
State	:	NY
Zip	:	10019-7400
Country	:	US
Telephone Number	:	347-556-2014
Fax Number	:

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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