Healthcare Provider Details

I. General information

NPI: 1689184459
Provider Name (Legal Business Name): SEAN DELLASPERANZO PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 SUNRISE HWY
MASSAPEQUA PARK NY
11762-2911
US

IV. Provider business mailing address

422 OLD FARMINGDALE RD
WEST BABYLON NY
11704-6424
US

V. Phone/Fax

Practice location:
  • Phone: 516-500-1105
  • Fax: 516-385-1550
Mailing address:
  • Phone: 631-500-1105
  • Fax: 516-385-1550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402767
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: