Provider Demographics
NPI:1407624984
Name:AVANTAGGIATO, FEDERICA (MD)
Entity type:Individual
Prefix:
First Name:FEDERICA
Middle Name:
Last Name:AVANTAGGIATO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 GLEN HEAD RD STE 140
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1946
Mailing Address - Country:US
Mailing Address - Phone:516-759-4014
Mailing Address - Fax:516-759-4015
Practice Address - Street 1:333 GLEN HEAD RD
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1947
Practice Address - Country:US
Practice Address - Phone:516-759-4014
Practice Address - Fax:516-759-4015
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2025-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY3347252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program