Healthcare Provider Details

I. General information

NPI: 1962712331
Provider Name (Legal Business Name): MRS. SHARI LYNN RUGGIERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 SHADY TREE LN
PORT JEFFERSON NY
11777-1923
US

IV. Provider business mailing address

19 SHADY TREE LN
PORT JEFFERSON NY
11777-1923
US

V. Phone/Fax

Practice location:
  • Phone: 631-474-7006
  • Fax:
Mailing address:
  • Phone: 631-474-7006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: