Provider Demographics
NPI:1346714417
Name:LIMONCELLI-VEALEY, STEPHANIE A (LMT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:LIMONCELLI-VEALEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9851 VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:NY
Mailing Address - Zip Code:14006-9078
Mailing Address - Country:US
Mailing Address - Phone:716-598-3040
Mailing Address - Fax:
Practice Address - Street 1:2157 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2692
Practice Address - Country:US
Practice Address - Phone:716-862-1386
Practice Address - Fax:716-862-2009
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025115225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist