Healthcare Provider Details

I. General information

NPI: 1043761943
Provider Name (Legal Business Name): SHEILA FONTANA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHEILA YORK

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 GLENWOOD RD
GLENWOOD LANDING NY
11547-3005
US

IV. Provider business mailing address

114 GLENWOOD RD
GLENWOOD LANDING NY
11547-3005
US

V. Phone/Fax

Practice location:
  • Phone: 516-676-2497
  • Fax:
Mailing address:
  • Phone: 516-676-2497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number647975
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: