Provider Demographics
NPI:1821373200
Name:STALLONE, THERESA MARIA (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:MARIA
Last Name:STALLONE
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 1:125 WOHSEEPEE DR
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7130
Mailing Address - Country:US
Mailing Address - Phone:631-968-1147
Mailing Address - Fax:631-968-1832
Practice Address - Street 1:125 WOHSEEPEE DR
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7130
Practice Address - Country:US
Practice Address - Phone:631-968-1147
Practice Address - Fax:631-968-1832
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247818163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool