Provider Demographics
NPI:1700495710
Name:GRACE, NZINGA
Entity Type:Individual
Prefix:
First Name:NZINGA
Middle Name:
Last Name:GRACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 BEATTIE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1542
Mailing Address - Country:US
Mailing Address - Phone:315-440-0413
Mailing Address - Fax:
Practice Address - Street 1:109 S WARREN ST # 301
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1798
Practice Address - Country:US
Practice Address - Phone:315-569-4549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-26
Last Update Date:2020-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031136225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist