Provider Demographics
NPI:1437931466
Name:BARANELLO, SUMMER
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:
Last Name:BARANELLO
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 1:350 W MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-5630
Mailing Address - Country:US
Mailing Address - Phone:631-226-0388
Mailing Address - Fax:631-226-2992
Practice Address - Street 1:350 W MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-5630
Practice Address - Country:US
Practice Address - Phone:631-226-0388
Practice Address - Fax:631-226-2992
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical