Most Relevant Information
Provider Data
| NPI Number: | 1003555103 |
| Provider Name: | TIFFANY A SIACA |
| Entity Type: | Individual |
| Taxonomy Code: | 225700000X |
| Specialty: | Massage Therapist |
| License Number: | 030708-01 |
Most Important Dates
| Enumeration Date: | 05/27/2022 |
| Last Updated: | 05/27/2022 |
Provider Practice Location
935 N BROADWAY
N MASSAPEQUA
NY
117582308
Practice Location Phone/Fax
| Phone: | 5167075915 |
| Fax: |
Provider Mailing Location
935 N BROADWAY
N MASSAPEQUA
NY
117582308
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |