Provider Demographics
NPI:1033185822
Name:SPERANDEO, VINCENT (DNP)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:SPERANDEO
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1174 ROUTE 112
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-8033
Mailing Address - Country:US
Mailing Address - Phone:631-320-7503
Mailing Address - Fax:631-880-4411
Practice Address - Street 1:1174 ROUTE 112
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-8033
Practice Address - Country:US
Practice Address - Phone:631-320-7503
Practice Address - Fax:631-880-4411
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF33169-1207P00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02426382Medicaid
P00287733OtherRAILROAD
NY1229G1OtherBCBS
NY02426382Medicaid
P48138Medicare UPIN