Provider Demographics
NPI:1760180723
Name:SGAMBATI, OLIVIA ALEXANDRA
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:ALEXANDRA
Last Name:SGAMBATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:ALEXANDRA
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:306 IMPERIAL WAY
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-1516
Mailing Address - Country:US
Mailing Address - Phone:631-617-2195
Mailing Address - Fax:
Practice Address - Street 1:306 IMPERIAL WAY
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1516
Practice Address - Country:US
Practice Address - Phone:631-617-2195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
No174400000XOther Service ProvidersSpecialist