MEDICARE: THAISA MARIA SIMPLICIO LEMOS CLC

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	174N00000X	Lactation Consultant (Non-RN)	ALPP-252818
2	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1780199075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAISA MARIA SIMPLICIO LEMOS CLC

Provider Business Mailing Address
First Line	:	49 IRVING PL APT 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-2508
Country	:	US
Telephone Number	:	347-766-4636
Fax Number	:

Provider Business Practice Location Address
First Line	:	49 IRVING PL APT 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-2508
Country	:	US
Telephone Number	:	347-766-4636
Fax Number	:

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

Provider Enumeration Date	:	12/08/2017
Last Update Date	:	12/08/2017

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