Healthcare Provider Details

I. General information

NPI: 1982980579
Provider Name (Legal Business Name): DEBORAH ANN SWEET RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1477 S SCHODACK RD
CASTLETON NY
12033-9644
US

IV. Provider business mailing address

1477 SOUTH SCHODACK RD
CASTLETON NY
12033
US

V. Phone/Fax

Practice location:
  • Phone: 518-732-7736
  • Fax: 518-732-0493
Mailing address:
  • Phone: 518-732-7736
  • Fax: 518-732-0493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number266391-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: