Provider Demographics
NPI:1851863534
Name:AMBROSIO, LAURA ASHLEY (NP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ASHLEY
Last Name:AMBROSIO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 SUNNYSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2946
Mailing Address - Country:US
Mailing Address - Phone:516-832-7100
Mailing Address - Fax:
Practice Address - Street 1:99 SUNNYSIDE BLVD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2946
Practice Address - Country:US
Practice Address - Phone:516-832-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307957-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health