Provider Demographics
NPI:1295964401
Name:PELAEZ, AWILDA (LMT)
Entity type:Individual
Prefix:MRS
First Name:AWILDA
Middle Name:
Last Name:PELAEZ
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 1:700-60 PATCHOGUE-YAPHANK ROAD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763
Mailing Address - Country:US
Mailing Address - Phone:516-380-1893
Mailing Address - Fax:631-775-8449
Practice Address - Street 1:700 PATCHOGUE YAPHANK RD STE 60
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-2239
Practice Address - Country:US
Practice Address - Phone:516-380-1893
Practice Address - Fax:631-775-8449
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist