Provider Demographics
NPI:1154934701
Name:GUCCIONE, MARYKATE VARNAVIDES (DNP, CPNP)
Entity type:Individual
Prefix:
First Name:MARYKATE
Middle Name:VARNAVIDES
Last Name:GUCCIONE
Suffix:
Gender:F
Credentials:DNP, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 GODWIN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-3338
Mailing Address - Country:US
Mailing Address - Phone:845-853-5258
Mailing Address - Fax:
Practice Address - Street 1:448 TEMPLE HILL RD
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-5510
Practice Address - Country:US
Practice Address - Phone:845-562-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY383108363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics