Provider Demographics
NPI:1396044905
Name:SWEZEY, DIANE MARGUERITE (NP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MARGUERITE
Last Name:SWEZEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BEACH DR
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4929
Mailing Address - Country:US
Mailing Address - Phone:631-587-1600
Mailing Address - Fax:
Practice Address - Street 1:111 BEACH DR
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4929
Practice Address - Country:US
Practice Address - Phone:631-587-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3027301251G00000X
NYF-302730-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY331544Medicare Oscar/Certification