Provider Demographics
NPI:1952967135
Name:NASTO, LAURA EMILY
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:EMILY
Last Name:NASTO
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 1:130 CAMPBELL AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13495-1712
Mailing Address - Country:US
Mailing Address - Phone:315-292-3075
Mailing Address - Fax:
Practice Address - Street 1:130 CAMPBELL AVE APT 2
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:NY
Practice Address - Zip Code:13495-1712
Practice Address - Country:US
Practice Address - Phone:315-292-3075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025989225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty