Provider Demographics
NPI:1043761943
Name:FONTANA, SHEILA (RN)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:FONTANA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:YORK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:114 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD LANDING
Mailing Address - State:NY
Mailing Address - Zip Code:11547-3005
Mailing Address - Country:US
Mailing Address - Phone:516-676-2497
Mailing Address - Fax:
Practice Address - Street 1:114 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:GLENWOOD LANDING
Practice Address - State:NY
Practice Address - Zip Code:11547-3005
Practice Address - Country:US
Practice Address - Phone:516-676-2497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY647975163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse