Healthcare Provider Details

I. General information

NPI: 1245636638
Provider Name (Legal Business Name): DAVID SPERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 MIDDLE COUNTRY RD
CORAM NY
11727-4425
US

IV. Provider business mailing address

1 E ROE BLVD
PATCHOGUE NY
11772-2631
US

V. Phone/Fax

Practice location:
  • Phone: 631-698-1111
  • Fax: 631-698-1195
Mailing address:
  • Phone: 631-475-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF338863-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: