Healthcare Provider Details

I. General information

NPI: 1275515421
Provider Name (Legal Business Name): ANDREA ZULLO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 JERICHO TPKE
SYOSSET NY
11791-4515
US

IV. Provider business mailing address

68 SOUTH SERVICE ROAD SUITE 350
MELVILLE NY
11747-2358
US

V. Phone/Fax

Practice location:
  • Phone: 516-496-6447
  • Fax:
Mailing address:
  • Phone: 516-945-3000
  • Fax: 516-945-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number3854531
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number385453-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: