Provider Demographics
NPI:1275634693
Name:VAGNINI, MARY ANN (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:VAGNINI
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:STONY BROOK UNIVERSITY CANCER CTR
Mailing Address - Street 2:3 EDMUND PELLEGRINO ROAD
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-628-1000
Mailing Address - Fax:631-628-0991
Practice Address - Street 1:STONY BROOK UNIVERSITY CANCER CTR
Practice Address - Street 2:3 EDMUND PELLEGRINO ROAD
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-628-1000
Practice Address - Fax:631-628-0991
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF334616363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ77569Medicare UPIN