MEDICARE: SONCIEARAY CHAVELA-AMOY ESSIX 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	MA81778	FL

General Provider Information

NPI Number	:	1538672464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONCIEARAY CHAVELA-AMOY ESSIX LMT

Provider Business Mailing Address
First Line	:	200 N ANDREWS AVE STE 101
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-1003
Country	:	US
Telephone Number	:	561-717-9976
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 N ANDREWS AVE STE 101
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-1003
Country	:	US
Telephone Number	:	561-717-9976
Fax Number	:

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

Provider Enumeration Date	:	11/14/2017
Last Update Date	:	11/14/2017

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