Provider Demographics
NPI:1609143056
Name:DECANDIO, DENE (LMT)
Entity Type:Individual
Prefix:MR
First Name:DENE
Middle Name:
Last Name:DECANDIO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WENTWORTH DR
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118-1636
Mailing Address - Country:US
Mailing Address - Phone:561-386-7026
Mailing Address - Fax:
Practice Address - Street 1:310 S DIXIE HWY
Practice Address - Street 2:APT 1
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-5838
Practice Address - Country:US
Practice Address - Phone:561-386-7026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT011078225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty