Provider Demographics
NPI:1003949058
Name:SPEED, JANET LEE (RN)
Entity Type:Individual
Prefix:
First Name:JANET LEE
Middle Name:
Last Name:SPEED
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JANET LEE
Other - Middle Name:
Other - Last Name:PETRINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 W JOHN ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-1020
Mailing Address - Country:US
Mailing Address - Phone:516-933-0485
Mailing Address - Fax:
Practice Address - Street 1:120 W JOHN ST
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-1020
Practice Address - Country:US
Practice Address - Phone:516-933-0485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235079163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01619823Medicaid