Provider Demographics
NPI:1598838658
Name:SPOSATO, KYRA (MS, NP)
Entity Type:Individual
Prefix:MS
First Name:KYRA
Middle Name:
Last Name:SPOSATO
Suffix:
Gender:F
Credentials:MS, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MANSION DR
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1006
Mailing Address - Country:US
Mailing Address - Phone:516-671-3120
Mailing Address - Fax:516-671-3120
Practice Address - Street 1:12 MANSION DR
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-1006
Practice Address - Country:US
Practice Address - Phone:516-671-3120
Practice Address - Fax:516-671-3120
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400362363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY91V981Medicare UPIN