Provider Demographics
NPI:1346531878
Name:SACCENTO, SAMANTHA LYNNE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LYNNE
Last Name:SACCENTO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:135 SULLY'S TRAIL
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534
Mailing Address - Country:US
Mailing Address - Phone:585-381-1117
Mailing Address - Fax:585-542-5623
Practice Address - Street 1:135 SULLY'S TRAIL SUITE 6
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534
Practice Address - Country:US
Practice Address - Phone:585-381-1117
Practice Address - Fax:585-542-5623
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27020198225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist