Provider Demographics
NPI:1164948238
Name:MASTRO, HEATHER ASHLEY (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ASHLEY
Last Name:MASTRO
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5648 DUTCH ST
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:NY
Mailing Address - Zip Code:14837-9746
Mailing Address - Country:US
Mailing Address - Phone:607-382-4596
Mailing Address - Fax:315-748-5298
Practice Address - Street 1:5648 DUTCH STREET
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:NY
Practice Address - Zip Code:14837
Practice Address - Country:US
Practice Address - Phone:607-382-4596
Practice Address - Fax:315-748-5298
Is Sole Proprietor?:No
Enumeration Date:2017-08-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0000174N00000X
174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN