Provider Demographics
NPI:1568021525
Name:OTTAVIANO, SIERRA CLAIRE
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:CLAIRE
Last Name:OTTAVIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:CLAIRE
Other - Last Name:WININGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 2ND ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4871
Mailing Address - Country:US
Mailing Address - Phone:209-743-6497
Mailing Address - Fax:
Practice Address - Street 1:1275 YORK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6007
Practice Address - Country:US
Practice Address - Phone:212-639-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY137746367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program