Healthcare Provider Details

I. General information

NPI: 1932054590
Provider Name (Legal Business Name): MICHAEL SWEENEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2026
Last Update Date: 02/28/2026
Certification Date: 02/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 GREENLEAF AVE APT 10B
STATEN ISLAND NY
10310-2658
US

IV. Provider business mailing address

194 GREENLEAF AVE APT 10B
STATEN ISLAND NY
10310-2658
US

V. Phone/Fax

Practice location:
  • Phone: 347-466-0380
  • Fax:
Mailing address:
  • Phone: 347-466-0380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCRPA-P-9595
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: