Provider Demographics
NPI:1902489602
Name:MOYA, SIRNEY RONAL (MA68723)
Entity Type:Individual
Prefix:MR
First Name:SIRNEY
Middle Name:RONAL
Last Name:MOYA
Suffix:
Gender:M
Credentials:MA68723
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4401 LETO LAKES BLVD APT 307
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3756
Mailing Address - Country:US
Mailing Address - Phone:239-849-9018
Mailing Address - Fax:
Practice Address - Street 1:5011 W HILLSBOROUGH AVE STE M
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5309
Practice Address - Country:US
Practice Address - Phone:813-249-7374
Practice Address - Fax:813-249-6969
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA68723225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty