Most Relevant Information
Provider Data
| NPI Number: | 1003656703 |
| Provider Name: | MICHELLE DESTEFANO |
| Entity Type: | Individual |
| Taxonomy Code: | 225700000X |
| Specialty: | Massage Therapist |
| License Number: | 013796 |
Most Important Dates
| Enumeration Date: | 05/30/2024 |
| Last Updated: | 05/30/2024 |
Provider Practice Location
340 VETERANS MEMORIAL HWY STE 10
COMMACK
NY
117254300
Practice Location Phone/Fax
| Phone: | 6317763019 |
| Fax: |
Provider Mailing Location
340 VETERANS MEMORIAL HWY STE 10
COMMACK
NY
117254300
Provider Mailing Phone/Fax
| Phone: | 6317763019 |
| Fax: | 6317763018 |