Provider Demographics
NPI:1447657192
Name:FORTUNATO, DORI (DAOM, LIC AC LMT)
Entity type:Individual
Prefix:DR
First Name:DORI
Middle Name:
Last Name:FORTUNATO
Suffix:
Gender:F
Credentials:DAOM, LIC AC LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1142
Mailing Address - Street 2:
Mailing Address - City:SHELTER ISLAND HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11965-1142
Mailing Address - Country:US
Mailing Address - Phone:631-374-2728
Mailing Address - Fax:
Practice Address - Street 1:2228 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:BRIDGEHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11932-4001
Practice Address - Country:US
Practice Address - Phone:631-500-5452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27027339225700000X
NY25005472171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist