Provider Demographics
NPI:1467085886
Name:CANDIDUS, PAULA (LMT)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:
Last Name:CANDIDUS
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 1:50B MERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3654
Mailing Address - Country:US
Mailing Address - Phone:516-986-9512
Mailing Address - Fax:
Practice Address - Street 1:50B MERRICK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3654
Practice Address - Country:US
Practice Address - Phone:516-986-9512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
009286225700000X
NY009286225700000X
NY009286-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty