Provider Demographics
NPI:1316451024
Name:SQUERI, BRITTANY GRACE
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:GRACE
Last Name:SQUERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-2620
Mailing Address - Country:US
Mailing Address - Phone:631-355-9574
Mailing Address - Fax:
Practice Address - Street 1:1121 5TH AVE
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-2620
Practice Address - Country:US
Practice Address - Phone:631-355-9574
Practice Address - Fax:631-355-9574
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program