Provider Demographics
NPI:1912703083
Name:PADOVANO, DEBRA CRISTINA
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:CRISTINA
Last Name:PADOVANO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4875 SUNRISE HWY STE 302
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-4630
Mailing Address - Country:US
Mailing Address - Phone:631-343-4184
Mailing Address - Fax:
Practice Address - Street 1:4875 SUNRISE HWY STE 302
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-4630
Practice Address - Country:US
Practice Address - Phone:631-343-4184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004927-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist