MEDICARE: EMMANUELLA E VIARD NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	402836	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033353958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMANUELLA E VIARD NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	1241 DEER PARK AVE STE 1
Second Line	:
City	:	NORTH BABYLON
State	:	NY
Zip	:	11703-3114
Country	:	US
Telephone Number	:	631-621-8348
Fax Number	:

Provider Business Practice Location Address
First Line	:	854 SUNRISE HWY # 1037
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-5908
Country	:	US
Telephone Number	:	631-621-8348
Fax Number	:	563-200-5520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2009
Last Update Date	:	10/20/2025

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Directions to “ EMMANUELLA E VIARD NURSE PRACTITIONER” Practice Location

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