MEDICARE: LILIANA FAZENDEIRO PTA

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	020287	NY
2	225200000X	Physical Therapy Assistant	0057821	NY

General Provider Information

NPI Number	:	1992775613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILIANA FAZENDEIRO PTA

Provider Business Mailing Address
First Line	:	15 VALORIE RD
Second Line	:
City	:	SOUTHAMPTON
State	:	NY
Zip	:	11968-2308
Country	:	US
Telephone Number	:	631-356-2631
Fax Number	:

Provider Business Practice Location Address
First Line	:	34A BAY ST
Second Line	:
City	:	SAG HARBOR
State	:	NY
Zip	:	11963-3104
Country	:	US
Telephone Number	:	631-356-2631
Fax Number	:

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	08/22/2023

Similar Medicare Providers

1275503567 — SINEAD FITZGIBBON PT, PHD
Practice Location Address:

34 BAY ST
SAG HARBOR, NY
11963-3104

Practice Phone: 631-725-4450
Practice Fax: 631-725-6206

1346432077 — MISS ILONA KATARZYNA POLAK M.D.
Practice Location Address:

34 BAY ST # 103
SAG HARBOR, NY
11963-3104

Practice Phone: 631-808-3337
Practice Fax: 631-808-3339

1699058958 — MEDICAL OFFICE OF DOCTOR ILONA K POLAK PC
Practice Location Address:

34 BAY ST # 103
SAG HARBOR, NY
11963-3104

Practice Phone: 631-808-3337
Practice Fax: 631-808-3338

1346849437 — STEPHANIE JOANNE ESPOSITO LMT, MLDC
Practice Location Address:

34 BAY ST STE 203
SAG HARBOR, NY
11963-3104

Practice Phone: 631-899-3216
Practice Fax:

1336865542 — VICTOR B. WEISS LMT
Practice Location Address:

34 BAY ST
SAG HARBOR, NY
11963-3104

Practice Phone: 631-839-0388
Practice Fax:

1326816992 — LATITUDE PHYSICAL THERAPY
Practice Location Address:

34 BAY ST STE 205-206
SAG HARBOR, NY
11963-3104

Practice Phone: 631-241-3698
Practice Fax:

Directions to “ LILIANA FAZENDEIRO PTA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.