Provider Demographics
NPI:1275316614
Name:SITARAS, JOANNE MARIE
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:MARIE
Last Name:SITARAS
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 1:251 LONG ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1806
Mailing Address - Country:US
Mailing Address - Phone:718-844-0102
Mailing Address - Fax:
Practice Address - Street 1:251 LONG ISLAND AVE
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1806
Practice Address - Country:US
Practice Address - Phone:718-844-0102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009669-01224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant