Provider Demographics
NPI:1619654761
Name:SGARLATA, GENEVIEVE NADINE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:GENEVIEVE
Middle Name:NADINE
Last Name:SGARLATA
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 1:4914 NY-365
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NY
Mailing Address - Zip Code:13478
Mailing Address - Country:US
Mailing Address - Phone:315-415-7554
Mailing Address - Fax:
Practice Address - Street 1:4914 NY-365
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NY
Practice Address - Zip Code:13478
Practice Address - Country:US
Practice Address - Phone:315-415-7554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030076225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist