Provider Demographics
NPI:1467809103
Name:JOHN, SWEETY (FNP)
Entity Type:Individual
Prefix:
First Name:SWEETY
Middle Name:
Last Name:JOHN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51-55 ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:WEST HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10993-2528
Mailing Address - Country:US
Mailing Address - Phone:845-786-4829
Mailing Address - Fax:
Practice Address - Street 1:51-55 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993-1099
Practice Address - Country:US
Practice Address - Phone:458-786-4829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340597363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily