Healthcare Provider Details

I. General information

NPI: 1487806238
Provider Name (Legal Business Name): SHANNON L POSTIGLIONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 1ST ST # GP4 WINTHROP HOSPITAL DEPT OF TCV
MINEOLA NY
11501-3957
US

IV. Provider business mailing address

259 1ST ST # GP4 WINTHROP HOSPITAL DEPT OF TCV
MINEOLA NY
11501-3957
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-2384
  • Fax:
Mailing address:
  • Phone: 516-663-2384
  • Fax: 516-663-8288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number012722-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: