Provider Demographics
NPI:1114679339
Name:SWEET, SERENE H
Entity Type:Individual
Prefix:
First Name:SERENE
Middle Name:H
Last Name:SWEET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6075 COUNTY ROAD 31A
Mailing Address - Street 2:
Mailing Address - City:SCIO
Mailing Address - State:NY
Mailing Address - Zip Code:14880-9756
Mailing Address - Country:US
Mailing Address - Phone:618-804-1512
Mailing Address - Fax:
Practice Address - Street 1:7309 SENECA RD N
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-9691
Practice Address - Country:US
Practice Address - Phone:607-282-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY720500-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161039939Medicaid
NY161039939OtherALL OTHER INSURANCES