MEDICARE: MONIQUE SYLVERS

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	032926-01	NY

General Provider Information

NPI Number	:	1912624677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE SYLVERS

Provider Business Mailing Address
First Line	:	124 SMITH ST APT 1C
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-4466
Country	:	US
Telephone Number	:	516-543-1455
Fax Number	:

Provider Business Practice Location Address
First Line	:	294 W MERRICK RD STE 10
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-3357
Country	:	US
Telephone Number	:	516-543-1455
Fax Number	:

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

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	10/24/2022

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