Provider Demographics
NPI:1396874012
Name:SICILIANO, AMBER LAEL (LMT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LAEL
Last Name:SICILIANO
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 1:3960 54TH ST
Mailing Address - Street 2:APT. 9D
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4237
Mailing Address - Country:US
Mailing Address - Phone:347-556-2014
Mailing Address - Fax:
Practice Address - Street 1:250 W 49TH ST
Practice Address - Street 2:SUITE 503
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-7400
Practice Address - Country:US
Practice Address - Phone:347-556-2014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020735225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist