Healthcare Provider Details

I. General information

NPI: 1164084398
Provider Name (Legal Business Name): MARCELA I SCHIAPPACASSE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57190 MAIN RD
SOUTHOLD NY
11971-4750
US

IV. Provider business mailing address

11 SHERWOOD RD
HAMPTON BAYS NY
11946-3612
US

V. Phone/Fax

Practice location:
  • Phone: 631-626-1006
  • Fax:
Mailing address:
  • Phone: 631-965-3895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number308897
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: