Provider Demographics
NPI:1790595304
Name:ENCALADA, TABATHA A (LMT, CBD, CRM)
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:A
Last Name:ENCALADA
Suffix:
Gender:F
Credentials:LMT, CBD, CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 COOPER LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-4810
Mailing Address - Country:US
Mailing Address - Phone:516-637-7216
Mailing Address - Fax:
Practice Address - Street 1:2 DUBON CT
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-1031
Practice Address - Country:US
Practice Address - Phone:516-637-7216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374J00000X
NY027799-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoula
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty