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General NPI Number Information
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NPI Number | 1790909547
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Entity Type | Individual
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Provider Name | KATRINA GUGLIELMO RPA-C
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Gender | Female
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 433 LAKE AVE
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City | SAINT JAMES
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State | NY
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Zip | 11780-2207
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Country | US
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Telephone | 163-158-4601
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Fax |
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Provider Business Mailing Address
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Address Line | 200 HOWELLS RD
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City | BAY SHORE
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State | NY
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Zip | 11706-5351
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Country | US
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Telephone | 631-666-1956
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Fax | 631-666-1957
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 005502
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License Number State | NY
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