Provider Demographics
NPI:1346542636
Name:RODILLADO, SHARYN PASAPORTE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:SHARYN
Middle Name:PASAPORTE
Last Name:RODILLADO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15A VINE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8922
Mailing Address - Country:US
Mailing Address - Phone:631-506-9768
Mailing Address - Fax:
Practice Address - Street 1:15A VINE RD
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8922
Practice Address - Country:US
Practice Address - Phone:631-506-9768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY586224163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse