Provider Demographics
NPI:1205393428
Name:SPAGNOLA, JUDY GIOVINAZZO (LAC)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:GIOVINAZZO
Last Name:SPAGNOLA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 IVY LN
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-3246
Mailing Address - Country:US
Mailing Address - Phone:215-880-3579
Mailing Address - Fax:
Practice Address - Street 1:85 IVY LN
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-3246
Practice Address - Country:US
Practice Address - Phone:215-880-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-24
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001270171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty