Provider Demographics
NPI:1396803540
Name:GUERRAZZI, ANGELA V (PSYCHIATRIC NURSE PR)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:V
Last Name:GUERRAZZI
Suffix:
Gender:F
Credentials:PSYCHIATRIC NURSE PR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2250
Mailing Address - Country:US
Mailing Address - Phone:631-807-1726
Mailing Address - Fax:631-846-4478
Practice Address - Street 1:69 GRASSLANDS CIRCLE
Practice Address - Street 2:
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766
Practice Address - Country:US
Practice Address - Phone:631-807-1726
Practice Address - Fax:631-828-4245
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF4004341363L00000X
NYF400434363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02585528Medicaid
Q49852Medicare UPIN
NY1207G1Medicare PIN