Provider Demographics
NPI:1811403702
Name:BOCCIO, SARA RENEE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:RENEE
Last Name:BOCCIO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 WEYFORD TER
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1114
Mailing Address - Country:US
Mailing Address - Phone:516-635-2008
Mailing Address - Fax:
Practice Address - Street 1:762 DEER PARK RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6221
Practice Address - Country:US
Practice Address - Phone:631-254-0094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY716749-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool