Healthcare Provider Details

I. General information

NPI: 1346107638
Provider Name (Legal Business Name): JULIEANN ROSE MAURO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 E MAIN ST
SMITHTOWN NY
11787-2888
US

IV. Provider business mailing address

180 E MAIN ST
SMITHTOWN NY
11787-2888
US

V. Phone/Fax

Practice location:
  • Phone: 631-265-6868
  • Fax: 631-265-6890
Mailing address:
  • Phone: 631-375-7779
  • Fax: 631-265-6890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407522
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: