MEDICARE: MR. DENE DECANDIO 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	CT011078	CT

General Provider Information

NPI Number	:	1609143056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENE DECANDIO LMT

Provider Business Mailing Address
First Line	:	28 WENTWORTH DR
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06118-1636
Country	:	US
Telephone Number	:	561-386-7026
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 S DIXIE HWY
Second Line	:	APT 1
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-5838
Country	:	US
Telephone Number	:	561-386-7026
Fax Number	:

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

Provider Enumeration Date	:	11/29/2011
Last Update Date	:	12/13/2022

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