Healthcare Provider Details

I. General information

NPI: 1750546727
Provider Name (Legal Business Name): PATRICIA ANNE GUERCIO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HSC T16 ROOM 080 NICHOLLS ROAD
STONYBROOK NY
11794
US

IV. Provider business mailing address

HSC T16 ROOM 080 NICHOLLS ROAD
STONYBROOK NY
11794
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-1066
  • Fax: 631-444-1054
Mailing address:
  • Phone: 631-444-1066
  • Fax: 631-444-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF302435
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: