Provider Demographics
NPI:1184848251
Name:SOMMERSON, GLORIA MARIA (RN)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:MARIA
Last Name:SOMMERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-4327
Mailing Address - Country:US
Mailing Address - Phone:631-234-4077
Mailing Address - Fax:631-669-1471
Practice Address - Street 1:1 FARMINGDALE RD
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-6545
Practice Address - Country:US
Practice Address - Phone:631-669-5355
Practice Address - Fax:631-669-1471
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY448024-1163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health