Provider Demographics
NPI:1063955474
Name:FLORA, GIANNA (PA)
Entity type:Individual
Prefix:
First Name:GIANNA
Middle Name:
Last Name:FLORA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3159
Mailing Address - Country:US
Mailing Address - Phone:631-654-9400
Mailing Address - Fax:631-654-8616
Practice Address - Street 1:200 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3159
Practice Address - Country:US
Practice Address - Phone:631-654-9400
Practice Address - Fax:631-654-8616
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020376363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical