Provider Demographics
NPI:1639390792
Name:PLACELLA, SHARON G (MS RN CS NPP APRN BC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:G
Last Name:PLACELLA
Suffix:
Gender:F
Credentials:MS RN CS NPP APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 JASMINE LANE
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-3617
Mailing Address - Country:US
Mailing Address - Phone:631-266-3863
Mailing Address - Fax:
Practice Address - Street 1:554 LARKFIELD RD
Practice Address - Street 2:SUTIE 10C
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-3617
Practice Address - Country:US
Practice Address - Phone:631-368-3966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2928931163WP0809X
NYF4000751363LP0808X
NY364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Not Answered364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRZ0421Medicare ID - Type Unspecified