Provider Demographics
NPI:1184175960
Name:VIEIRA, GISELI (LMT)
Entity type:Individual
Prefix:
First Name:GISELI
Middle Name:
Last Name:VIEIRA
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 1:20 CHAMPLAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFF STA
Mailing Address - State:NY
Mailing Address - Zip Code:11776-4435
Mailing Address - Country:US
Mailing Address - Phone:917-239-6677
Mailing Address - Fax:
Practice Address - Street 1:5 PARKRIDGE CIR
Practice Address - Street 2:
Practice Address - City:PORT JEFF STA
Practice Address - State:NY
Practice Address - Zip Code:11776-3414
Practice Address - Country:US
Practice Address - Phone:917-239-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007333171100000X
NY023730-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171100000XOther Service ProvidersAcupuncturist