Provider Demographics
NPI:1871920181
Name:FAUNTLEROY, LINDSAY CAROL (LAC)
Entity type:Individual
Prefix:MS
First Name:LINDSAY
Middle Name:CAROL
Last Name:FAUNTLEROY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 BROADWAY RM 505
Mailing Address - Street 2:SUITE 505
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7689
Mailing Address - Country:US
Mailing Address - Phone:718-913-0037
Mailing Address - Fax:
Practice Address - Street 1:1841 BROADWAY RM 505
Practice Address - Street 2:SUITE 505
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7689
Practice Address - Country:US
Practice Address - Phone:718-913-0037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005111171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist