Provider Demographics
NPI:1790234243
Name:FAMIGLIETTI, SHARON
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:FAMIGLIETTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 TULIP CT
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-2533
Mailing Address - Country:US
Mailing Address - Phone:631-730-6005
Mailing Address - Fax:
Practice Address - Street 1:12 TULIP CT
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-2533
Practice Address - Country:US
Practice Address - Phone:631-730-6005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY474545-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse