MEDICARE: MR. PETER STEVEN SPERICO FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	336101	NY
2	363L00000X	Nurse Practitioner	336101	NY
3	163W00000X	Registered Nurse	409409	NY

General Provider Information

NPI Number	:	1922337278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER STEVEN SPERICO FNP

Provider Business Mailing Address
First Line	:	1056 GARDINER DRIVE
Second Line	:	PETER SPERICO NURSE PRACTITIONER IN FAMILY HEALTH PC
City	:	BAY SHORE
State	:	NY
Zip	:	11706-6314
Country	:	US
Telephone Number	:	516-455-3413
Fax Number	:	631-969-0093

Provider Business Practice Location Address
First Line	:	1056 GARDINER DRIVE
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-6314
Country	:	US
Telephone Number	:	516-455-3413
Fax Number	:	631-969-0093

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2009
Last Update Date	:	03/15/2026

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