Healthcare Provider Details

I. General information

NPI: 1568021525
Provider Name (Legal Business Name): SIERRA CLAIRE OTTAVIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SIERRA CLAIRE WININGS

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

5 2ND ST APT 2
BROOKLYN NY
11231-4871
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-2323
  • Fax:
Mailing address:
  • Phone: 209-743-6497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number137746
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: