Jessica Maria Fasano, LMT, CLT, MLD-C

NPI #1649872805 in Syosset, New York

Provider Information

NPI Number: 1649872805
Entity Type: Individual
Name: Jessica Maria Fasano, LMT, CLT, MLD-C
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Massage Therapist
Credential: LMT, CLT, MLD-C
Enumeration Date: Nov 12, 2020
Last Updated: Nov 12, 2020

Practice Location

Address: 28 LILAC DR
City: Syosset
State: New York
ZIP Code: 11791-2815
Phone: (516) 250-4529

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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