Provider Demographics
NPI:1376365973
Name:LLOYD, MAKEBA (COMPLEMENTARY HEALTH)
Entity type:Individual
Prefix:
First Name:MAKEBA
Middle Name:
Last Name:LLOYD
Suffix:
Gender:F
Credentials:COMPLEMENTARY HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4080 BROADWAY # 219
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1572
Mailing Address - Country:US
Mailing Address - Phone:347-674-3638
Mailing Address - Fax:772-829-8806
Practice Address - Street 1:870 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-5215
Practice Address - Country:US
Practice Address - Phone:917-886-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225700000X, 171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1982349981OtherPREVENTATIVE CARE PRACTITIONER