Healthcare Provider Details

I. General information

NPI: 1194039784
Provider Name (Legal Business Name): LYNN A SEGERIVAS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 STATESMAN ST
BABYLON NY
11702-1310
US

IV. Provider business mailing address

1 E ROE BLVD
PATCHOGUE NY
11772-2631
US

V. Phone/Fax

Practice location:
  • Phone: 631-957-5383
  • Fax:
Mailing address:
  • Phone: 631-475-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number505157
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344553
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: